Dwight W Perkins, CRNA

Individual provider Active NPI Certified Registered Nurse Anesthetist · Stanley, WI

NPI 1710967484 · NPPES record last updated May 24, 2010

Key facts

NPI
1710967484
Entity type
Individual (NPI type 1)
Primary specialty
Certified Registered Nurse Anesthetist 367500000X
License
246-033 (WI)
Practice address
1120 Pine St
Stanley, WI 54768-1297
Phone
(715) 644-5571
Fax
(715) 644-6220
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
246-033WIMDCertified Registered Nurse Anesthetist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 246-033 WI Yes

Addresses

Primary practice location

1120 Pine St
Stanley, WI 54768-1297

Mailing address

1120 Pine St
Stanley, WI 54768-1297
Phone (715) 644-5571

Other identifiers

IdentifierTypeStateIssuer
43302600MedicaidWI

Other providers in Stanley, WI

All providers in Stanley, WI · Certified Registered Nurse Anesthetist in Wisconsin

Sources for this page

Verify at the official NPI Registry.