Individual
KATHARINE M DIVYAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
Mailing address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
199770
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184177321
—
WI
Enumeration date
07/24/2016
Last updated
05/05/2021
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