Healthcare Provider Details

I. General information

NPI: 1881179299
Provider Name (Legal Business Name): ANDREA C HOLYSZKO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA CARLSON

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 S 27TH ST
FRANKLIN WI
53132-8034
US

IV. Provider business mailing address

1275 RIDGE RD
WAUKESHA WI
53186-1426
US

V. Phone/Fax

Practice location:
  • Phone: 414-574-0253
  • Fax:
Mailing address:
  • Phone: 262-271-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number193840
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: