Provider Demographics
NPI:1093827628
Name:BINGNER, ERIC CLARK (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CLARK
Last Name:BINGNER
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:N1607 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-8736
Mailing Address - Country:US
Mailing Address - Phone:920-568-0436
Mailing Address - Fax:
Practice Address - Street 1:N1607 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-8736
Practice Address - Country:US
Practice Address - Phone:920-568-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI644-033207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43362700Medicaid
46259OtherAANA #