Kothbauer, Staci M

Kothbauer, Staci M is an individual health care provider with primary practice located at 700 S Park St , Madison WI 53715-1830. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Kothbauer, Staci M can be contacted via phone (608) 251-6100.

Contact Information

Primary practice address
700 S Park St Madison WI 53715-1830
Phone: (608) 251-6100
Fax: (608) 258-5222
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 13813430 Wisconsin

Profile Details

NPI number 1225004757
LBN Legal business name Kothbauer, Staci M
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 24th, 2006
Last updated Dec 4th, 2020 - about 4 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 1225004757 NPPES
Wisconsin MEDICAID 1225004757

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