Individual
TOM R PANKRATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
042315
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009390
PHYS PLUS PROV #
WI
01
—
388407992
TRICARE PROV #
WI
01
—
391023846
COMMERCIAL INS PROV #
WI
01
—
430054481
RR MEDICARE PROV #
WI
05
—
43322800
—
WI
01
—
551896
DEANCARE PROV #
WI
Enumeration date
11/17/2005
Last updated
03/09/2010
Update your record
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