Individual
BRADLEY J BOETTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 445-7222
(920) 445-7289
Mailing address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 445-7222
(920) 445-7289
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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