Healthcare Provider Details

I. General information

NPI: 1982669412
Provider Name (Legal Business Name): CRAIG A TOKACH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 JACKSON ST SUITE E
OSHKOSH WI
54901-8144
US

IV. Provider business mailing address

3420 JACKSON DRIVE RD SUITE E
OSHKOSH WI
54901-8144
US

V. Phone/Fax

Practice location:
  • Phone: 920-426-2211
  • Fax: 920-426-2231
Mailing address:
  • Phone: 920-426-2211
  • Fax: 920-426-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number169-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: