Healthcare Provider Details

I. General information

NPI: 1689603243
Provider Name (Legal Business Name): GAZZZ GROUP SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 NEWBURY ST
RIPON WI
54971-1730
US

IV. Provider business mailing address

200 E WASHINGTON ST P O BOX 8031
APPLETON WI
54911-5490
US

V. Phone/Fax

Practice location:
  • Phone: 920-748-3101
  • Fax:
Mailing address:
  • Phone: 888-883-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MADELINE M PEREIRA
Title or Position: PRESIDENT
Credential: CRNA
Phone: 920-748-3101