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Individual

JAMES G VANBOMMEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
259 N PARK AVE, FOND DU LAC, WI 54935-3540
(920) 921-8528
Mailing address
259 N PARK AVE, FOND DU LAC, WI 54935-3540
(920) 921-8528

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
126-033
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
43418500
WI
Enumeration date
03/01/2007
Last updated
07/08/2007
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