Healthcare Provider Details

I. General information

NPI: 1821252123
Provider Name (Legal Business Name): DAVID SCOTT LENNINGER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 01/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

IV. Provider business mailing address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-6161
  • Fax: 608-847-3881
Mailing address:
  • Phone: 608-847-6161
  • Fax: 608-847-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD-110948
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: