Individual
MATTHEW EVAN PERSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1396
(920) 738-2000
Mailing address
1224 CARPENTER ST, MENASHA, WI 54952-9446
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
134316
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2021
Last updated
05/29/2021
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