Provider Demographics
NPI:1083870927
Name:ROSSI, ANDREA KAY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KAY
Last Name:ROSSI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 POWERS ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4656
Mailing Address - Country:US
Mailing Address - Phone:920-203-3596
Mailing Address - Fax:
Practice Address - Street 1:723 POWERS ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4656
Practice Address - Country:US
Practice Address - Phone:920-203-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7509-33367500000X
WI157939-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35029900Medicaid