Individual
MARK J. KERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
620 W BROWN ST, WAUPUN, WI 53963-1702
(920) 324-5581
(920) 926-8370
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8332
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
111617
WI
363L00000X
Nurse Practitioner
138
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
029908
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43331900
—
WI
Enumeration date
11/01/2006
Last updated
04/11/2017
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