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NPI Code Detail

MEDICARE: ANGELA M. SERVIN CRNA

MEDICARE: ANGELA M. SERVIN CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist167391WI

General Provider Information

NPI Number : 1316181050
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA M. SERVIN CRNA
Provider Business Mailing Address
First Line : 1818 N MEADE ST
Second Line :
City : APPLETON
State : WI
Zip : 54911-3454
Country : US
Telephone Number : 920-202-3363
Fax Number : 920-939-3827
Provider Business Practice Location Address
First Line : 1818 N MEADE ST
Second Line :
City : APPLETON
State : WI
Zip : 54911-3454
Country : US
Telephone Number : 920-731-4101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2009
Last Update Date : 01/07/2026

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