Healthcare Provider Details

I. General information

NPI: 1841206620
Provider Name (Legal Business Name): ALFRED J WHITE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: A JAMES WHITE CRNA

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PLEASANT VALLEY RD
WEST BEND WI
53095-9274
US

IV. Provider business mailing address

PO BOX 78600
MILWAUKEE WI
53278-8600
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-5533
  • Fax:
Mailing address:
  • Phone: 414-777-1623
  • Fax: 414-777-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number42051-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: