Individual
TANYA FLORENCE WATERBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
221949
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
R 185512-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972934180
—
MN
Enumeration date
12/13/2013
Last updated
04/29/2015
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