Healthcare Provider Details

I. General information

NPI: 1629217153
Provider Name (Legal Business Name): MIGDIEL H MORETTA-VASQUEZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIGDIEL MORETTA

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-6100
  • Fax: 608-258-5222
Mailing address:
  • Phone: 608-250-1497
  • Fax: 608-250-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number165762
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: