Healthcare Provider Details

I. General information

NPI: 1740399500
Provider Name (Legal Business Name): ANESTHETISTS INC. OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 HIGHWAY 46
DEER PARK WI
54007-7501
US

IV. Provider business mailing address

2302 HIGHWAY 46 P.O. BOX 159
DEER PARK WI
54007-7501
US

V. Phone/Fax

Practice location:
  • Phone: 715-269-5530
  • Fax: 715-269-5535
Mailing address:
  • Phone: 715-269-5530
  • Fax: 715-269-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. CURTIS W OLSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 715-269-5530