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NPI Code Detail

MEDICARE: VB ANESTHESIA

MEDICARE: VB ANESTHESIA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner126WI
2367500000XCertified Registered Nurse Anesthetist34013WI
3163W00000XRegistered Nurse74714030WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306840350
Entity Type Code : Organization
Provider Name (Legal Business Name) : VB ANESTHESIA
Provider Business Mailing Address
First Line : 259 N. PARK AVE.
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-3540
Country : US
Telephone Number : 920-921-2379
Fax Number : 920-921-2379
Provider Business Practice Location Address
First Line : 620 W BROWN ST
Second Line :
City : WAUPUN
State : WI
Zip : 53963-1702
Country : US
Telephone Number : 920-324-5581
Fax Number : 920-324-0291
Authorized Official
Title or Position : ANESTHESIA PROVIDER/ OWNER VB ANEST
Name : MR. JAMES G VANBOMMEL
Credential : CRNA APNO
Telephone Number : 920-921-2379
Provider Enumeration Date : 06/08/2005
Last Update Date : 07/31/2008

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Directions to “VB ANESTHESIA ” Practice Location

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