Antonissen, Jeffery P

Antonissen, Jeffery P is an individual health care provider with primary practice located at 2845 Greenbrier Rd , Green Bay WI 54311-6519. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Antonissen, Jeffery P can be contacted via phone (920) 288-3388.

Contact Information

Primary practice address
2845 Greenbrier Rd Green Bay WI 54311-6519
Phone: (920) 288-3388
Fax: (920) 288-3370
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 113583 Wisconsin

Profile Details

NPI number 1760494512
LBN Legal business name Antonissen, Jeffery P
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2006
Last updated Apr 9th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760494512 NPPES
Michigan MEDICAID 104521249
Michigan MEDICAID 104521230
Michigan MEDICAID 43399100
Michigan Other P00033987

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