Healthcare Provider Details

I. General information

NPI: 1154318848
Provider Name (Legal Business Name): TYLER SHEA HENSLEY DNAP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/21/2022
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

3801 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-4048
  • Fax:
Mailing address:
  • Phone: 262-687-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2764
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9172042
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN0000100367
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209014806
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0000009941
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN185701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: