Healthcare Provider Details

I. General information

NPI: 1306951496
Provider Name (Legal Business Name): WILLIAM J GARSKE JR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JR WILLIAM JAMES GARSKE

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 207-921-8400
  • Fax:
Mailing address:
  • Phone: 414-647-6326
  • Fax: 414-671-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number130757-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA133012
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: