Individual
JEFFERY P ANTONISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-3388
(920) 288-4863
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
(920) 405-8005
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
113583
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104521230
—
MI
05
—
104521249
—
MI
05
—
43399100
—
WI
01
—
P00033987
RAILROAD
WI
Enumeration date
08/12/2006
Last updated
04/21/2026
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