Healthcare Provider Details

I. General information

NPI: 1265447999
Provider Name (Legal Business Name): LYNNE M KREBS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNNE M HAWLEY-KREBS CRNA

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 S SILVERBROOK DR
WEST BEND WI
53095-3863
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: 262-335-0533
  • Fax:
Mailing address:
  • Phone: 866-313-0337
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54345-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: