Individual
MARY C PHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 887-7181
Mailing address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 887-7181
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5896
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265841589
—
WI
Enumeration date
08/12/2014
Last updated
03/18/2024
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