Provider Demographics
NPI:1073934048
Name:LYNNE M KREBS CRNA SC
Entity Type:Organization
Organization Name:LYNNE M KREBS CRNA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:262-335-0533
Mailing Address - Street 1:PO BOX 8031
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8031
Mailing Address - Country:US
Mailing Address - Phone:866-313-0337
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:W178N9912 RIVERCREST DR STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4645
Practice Address - Country:US
Practice Address - Phone:262-672-9000
Practice Address - Fax:262-290-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty