Healthcare Provider Details

I. General information

NPI: 1316181050
Provider Name (Legal Business Name): ANGELA M. SERVIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA M MOREY CRNA

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911-3454
US

IV. Provider business mailing address

1818 N MEADE ST
APPLETON WI
54911-3454
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-4101
  • Fax:
Mailing address:
  • Phone: 920-202-3363
  • Fax: 920-939-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number167391
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: