Healthcare Provider Details

I. General information

NPI: 1861191363
Provider Name (Legal Business Name): ANTHONY JOSEPH RYCHLOWSKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E DIVISION ST
FOND DU LAC WI
54935-4560
US

IV. Provider business mailing address

N6803 STREBLOW DR APT 2
FOND DU LAC WI
54937-8528
US

V. Phone/Fax

Practice location:
  • Phone: 920-929-2300
  • Fax:
Mailing address:
  • Phone: 414-897-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number240772-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14182-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: