Individual
MS. MARY CLARE NORDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9108
(715) 284-5361
(715) 284-7166
Mailing address
1212 HARRISON ST, BLACK RIVER FALLS, WI 54615-1906
(715) 284-9691
(715) 284-7166
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
71871
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002
SEQUENCE NUMBER
WI
01
—
1224
APNP REGISTRATION
WI
01
—
37187
AANA REGISTRATION
—
05
—
43352400
—
WI
01
—
71871
RN LICENSE
WI
Enumeration date
07/20/2006
Last updated
07/09/2007
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