Provider Demographics
NPI:1194079210
Name:DAUL ANESTHESIA INC
Entity type:Organization
Organization Name:DAUL ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAUL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:920-277-4358
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-2123
Mailing Address - Country:US
Mailing Address - Phone:920-451-8142
Mailing Address - Fax:
Practice Address - Street 1:W4855 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:WI
Practice Address - Zip Code:54169-9505
Practice Address - Country:US
Practice Address - Phone:920-277-4358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94321-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty