Individual
TODD E. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-2331
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049068
CRNA RECERTIFICATION CARD
—
05
—
43378100
—
WI
Enumeration date
12/15/2005
Last updated
07/09/2007
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