Healthcare Provider Details

I. General information

NPI: 1578540720
Provider Name (Legal Business Name): ERIN WILLIAM POOLE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE PATIENT FINANCIAL SERVICES
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE PATIENT FINANCIAL SERVICES
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-777-0376
  • Fax: 414-777-0033
Mailing address:
  • Phone: 414-777-0376
  • Fax: 414-777-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number83070030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: