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Individual

MRS. REBECCA LYNN STARK-JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
611 SHERMAN AVE E, FORT ATKINSON, WI 53538-1960
(920) 568-5000
(920) 568-5412
Mailing address
1013 W BLACKHAWK DR, FORT ATKINSON, WI 53538-1024
(920) 563-2726

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
60-033
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
43289800
WI
01
STARKREB
MERCYCARE
WI
Enumeration date
08/31/2006
Last updated
07/09/2007
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