Individual
BRADLEY J BOETTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
141347
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
3411
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141347
RN SECONDARY WI STATE LICENSE
WI
01
—
3411
WI STATE LICENSE
WI
Enumeration date
03/13/2008
Last updated
11/01/2018
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