Healthcare Provider Details

I. General information

NPI: 1174099634
Provider Name (Legal Business Name): SHANNA R BADJE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNA POPP

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-4123
US

IV. Provider business mailing address

3809 CLIFFSIDE DR APT 8
LA CROSSE WI
54601-8337
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8100
  • Fax:
Mailing address:
  • Phone: 262-749-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8923
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: