Provider Demographics
NPI:1104953090
Name:NEW ANESTHESIA
Entity type:Organization
Organization Name:NEW ANESTHESIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, MS
Authorized Official - Phone:920-450-6172
Mailing Address - Street 1:1236 STILLMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-8920
Mailing Address - Country:US
Mailing Address - Phone:920-450-6172
Mailing Address - Fax:
Practice Address - Street 1:1236 STILLMEADOW LN
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-8920
Practice Address - Country:US
Practice Address - Phone:920-450-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI054142282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access