| NPI | 1013006816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN J DOMKE Office Manager 920-361-5538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 367500000X Nurse Anesthetist, Certified Registered | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-11-05 |