Organization
VB ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES G VANBOMMEL CRNA APNO (ANESTHESIA PROVIDER/ OWNER VB ANEST)
(920) 921-2379
Entity
Organization
Contact information
Practice address
620 W BROWN ST, WAUPUN, WI 53963-1702
(920) 324-5581
(920) 324-0291
Mailing address
259 N. PARK AVE., FOND DU LAC, WI 54935-3540
(920) 921-2379
(920) 921-2379
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
74714030
WI
363L00000X
Nurse Practitioner
126
WI
367500000X
Certified Registered Nurse Anesthetist
34013
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43418500
—
WI
Enumeration date
06/08/2005
Last updated
07/31/2008
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