Individual
JAY P IRONSIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
80 1ST ST, PRAIRIE DU SAC, WI 53578-1550
(608) 643-7299
Mailing address
W14145 CREST VIEW DR, PRAIRIE DU SAC, WI 53578-9559
(608) 370-6282
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
147652
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43331500
—
WI
Enumeration date
04/27/2006
Last updated
05/23/2013
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