Healthcare Provider Details

I. General information

NPI: 1649912395
Provider Name (Legal Business Name): JUDY DOLCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDY DOLCE LILAVOIS CRNA

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W STOUT ST
RICE LAKE WI
54868-5000
US

IV. Provider business mailing address

8418 ROCKCREEK PKWY
CORDOVA TN
38016-4593
US

V. Phone/Fax

Practice location:
  • Phone: 715-236-8100
  • Fax:
Mailing address:
  • Phone: 954-559-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104156
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number31843
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberAPN0000031843
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: