Healthcare Provider Details

I. General information

NPI: 1023056058
Provider Name (Legal Business Name): DAVID BRAD BOGARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N WESTHAVEN DR
OSHKOSH WI
54904
US

IV. Provider business mailing address

855 N WESTHAVEN DR
OSHKOSH WI
54904-7668
US

V. Phone/Fax

Practice location:
  • Phone: 920-456-6000
  • Fax: 920-456-5590
Mailing address:
  • Phone: 920-456-6000
  • Fax: 920-456-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2465
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: