Kernan, Mark J.

Kernan, Mark J. is an individual health care provider with primary practice located at 620 W Brown St , Waupun WI 53963-1702. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Nursing Service Providers / Registered Nurse. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Kernan, Mark J. can be contacted via phone (920) 324-5581.

Contact Information

Primary practice address
620 W Brown St Waupun WI 53963-1702
Phone: (920) 324-5581
Fax: (920) 926-8370
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 029908 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 138 Wisconsin
Nursing Service Providers / Registered Nurse 163W00000X 111617 Wisconsin

Profile Details

NPI number 1609953157
LBN Legal business name Kernan, Mark J.
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2006
Last updated Apr 11th, 2017 - about 8 years ago

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 1609953157 NPPES
Wisconsin MEDICAID 43331900

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