Provider Demographics
NPI:1043316839
Name:JOHN E BUONORA CRNA, S.C.
Entity Type:Organization
Organization Name:JOHN E BUONORA CRNA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUONORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-303-5100
Mailing Address - Street 1:3420 JACKSON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-8144
Mailing Address - Country:US
Mailing Address - Phone:920-426-2211
Mailing Address - Fax:920-426-2231
Practice Address - Street 1:501 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2025
Practice Address - Country:US
Practice Address - Phone:920-303-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43388700Medicaid
WIS99505Medicare UPIN