Healthcare Provider Details

I. General information

NPI: 1922097351
Provider Name (Legal Business Name): THOMAS ROYCE SILBERNAGEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3708 RIVER AVE
NEILLSVILLE WI
54456-7218
US

IV. Provider business mailing address

N3708 RIVER AVE
NEILLSVILLE WI
54456-7218
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-3101
  • Fax: 715-743-6245
Mailing address:
  • Phone: 715-819-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1866-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: