Provider Demographics
NPI:1003899725
Name:KAMINSKY, FREDRICK (CRNA)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:
Last Name:KAMINSKY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 S SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:WI
Mailing Address - Zip Code:54612-1401
Mailing Address - Country:US
Mailing Address - Phone:608-323-3341
Mailing Address - Fax:608-323-2136
Practice Address - Street 1:464 S SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:WI
Practice Address - Zip Code:54612-1401
Practice Address - Country:US
Practice Address - Phone:608-323-3341
Practice Address - Fax:608-323-2136
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI437033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered