Healthcare Provider Details

I. General information

NPI: 1194079210
Provider Name (Legal Business Name): DAUL ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W4855 MUSTANG DR
SHERWOOD WI
54169-9505
US

IV. Provider business mailing address

PO BOX 2123
APPLETON WI
54912-2123
US

V. Phone/Fax

Practice location:
  • Phone: 920-277-4358
  • Fax:
Mailing address:
  • Phone: 920-451-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number94321-30
License Number StateWI

VIII. Authorized Official

Name: DENNIS D DAUL
Title or Position: PRESIDENT
Credential: CRNA
Phone: 920-277-4358