Healthcare Provider Details

I. General information

NPI: 1073627824
Provider Name (Legal Business Name): BARBARA A. ELAND C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S VAN BUREN ST
GREEN BAY WI
54301-3526
US

IV. Provider business mailing address

835 S VAN BUREN ST
GREEN BAY WI
54301-3526
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-0111
  • Fax: 920-431-3071
Mailing address:
  • Phone: 920-885-5692
  • Fax: 920-431-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209-005519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: