Healthcare Provider Details

I. General information

NPI: 1326151580
Provider Name (Legal Business Name): WILLIAM S. ROGERS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 NEW PINERY RD
PORTAGE WI
53901-9240
US

IV. Provider business mailing address

PO BOX 387
PORTAGE WI
53901-0387
US

V. Phone/Fax

Practice location:
  • Phone: 608-742-4131
  • Fax: 608-742-6098
Mailing address:
  • Phone: 608-742-4131
  • Fax: 608-742-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28144566A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041313670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: