Healthcare Provider Details

I. General information

NPI: 1609227826
Provider Name (Legal Business Name): WADE P BATEMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MINISTRY PKWY
WESTON WI
54476-5220
US

IV. Provider business mailing address

2056 ALFRED BLVD
NAVARRE FL
32566-7349
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-1000
  • Fax:
Mailing address:
  • Phone: 801-759-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number6703908-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11432
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9375019
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD168130
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: