Healthcare Provider Details

I. General information

NPI: 1801996731
Provider Name (Legal Business Name): JOHN NOLDIN CRNA APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S VAN BUREN ST
GREEN BAY WI
54301
US

IV. Provider business mailing address

PO BOX 13508
GREEN BAY WI
54307-3508
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-0111
  • Fax: 920-433-8765
Mailing address:
  • Phone: 920-433-0111
  • Fax: 920-433-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number88743-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: