Provider Demographics
NPI:1407833866
Name:KNAACK, KERI L (CRNA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:KNAACK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:L
Other - Last Name:BLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2107 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6130
Mailing Address - Country:US
Mailing Address - Phone:715-834-8721
Mailing Address - Fax:715-834-3087
Practice Address - Street 1:1221 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5270
Practice Address - Country:US
Practice Address - Phone:715-838-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI073619367500000X
WI115369367500000X
WI3401-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44344800Medicaid