Individual
MARK T LABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2817 NEW PINERY RD, PORTAGE, WI 53901-9257
(608) 742-4131
(608) 742-6098
Mailing address
2817 NEW PINERY ROAD, PO BOX 387, PORTAGE, WI 53901-0387
(608) 742-4131
(608) 742-6098
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
132420
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43387400
—
WI
Enumeration date
02/24/2006
Last updated
11/17/2022
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