Provider Demographics
NPI:1275518276
Name:ASCHENBRENER, THERESA A (CRNA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:ASCHENBRENER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:MARKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:225 S EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4266
Mailing Address - Country:US
Mailing Address - Phone:262-787-4026
Mailing Address - Fax:
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-656-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100352367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430050829OtherRAIL ROAD MEDICARE
WI43379100Medicaid
049493OtherCRNA RECERTIFICATION CARD
WI0002-32365Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI0003-32100Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI0011-21340Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI43379100Medicaid
430050829OtherRAIL ROAD MEDICARE
WI0007-32300Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI0002-46285Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI0013-21323Medicare ID - Type UnspecifiedPROVIDER NUMBER