Healthcare Provider Details

I. General information

NPI: 1417378464
Provider Name (Legal Business Name): ALLEN H SCHUT CRNA SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W178N9912 RIVERCREST DR STE 102
GERMANTOWN WI
53022-4645
US

IV. Provider business mailing address

PO BOX 8031
APPLETON WI
54912-8031
US

V. Phone/Fax

Practice location:
  • Phone: 262-672-6900
  • Fax: 262-290-2726
Mailing address:
  • Phone: 866-313-0337
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6939930
License Number StateWI

VIII. Authorized Official

Name: ALLEN H SCHUT
Title or Position: OWNER
Credential: CRNA
Phone: 262-338-1528