Healthcare Provider Details

I. General information

NPI: 1841485372
Provider Name (Legal Business Name): NOAH HORKHEIMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 MEMORIAL DR
TWO RIVERS WI
54241-3900
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-794-5000
  • Fax: 920-794-5388
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number160261
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: