VB Anesthesia

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

74714030 Issued in WI

Legal business name

VB ANESTHESIA

Practice address

620 W Brown St
Waupun, WI 53963-1702

Phone

(920) 324-5581

Fax

(920) 324-0291

NPI assigned

Jun 8, 2005

Last updated

Jul 31, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James G Vanbommel, CRNA APNO

Title

Anesthesia Provider/ Owner VB Anest

Phone

(920) 921-2379

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1306840350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 N. PARK AVE.",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353540",
            "telephone_number": "920-921-2379",
            "fax_number": "920-921-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631702",
            "telephone_number": "920-324-5581",
            "fax_number": "920-324-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VB ANESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "VANBOMMEL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ANESTHESIA PROVIDER/ OWNER VB ANEST",
        "authorized_official_telephone_number": "920-921-2379",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA APNO"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "74714030",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "126",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "34013",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43418500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Waupun, WI
• Providers in Waupun, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.