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General NPI Number Information
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NPI Number | 1669523239
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Entity Type | Individual
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Provider Name | ANTON P. MENTELE CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 1200 THIRD AVE WEST
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City | DURAND
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State | WI
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Zip | 54736
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Country | US
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Telephone | 715-672-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 THIRD AVE WEST
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City | DURAND
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State | WI
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Zip | 54736
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Country | US
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Telephone | 715-672-4211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 82923-030
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License Number State | WI
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