Individual
MICHAEL T. LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4908
WI
367500000X
Certified Registered Nurse Anesthetist
D162896
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188681-30
WI STATE LIC RN
WI
01
—
4908-33
APNP LIC
WI
Enumeration date
06/20/2012
Last updated
12/20/2021
Update your record
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