Provider Demographics
NPI:1528217130
Name:CALONDER, SETH P (CRNA)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:P
Last Name:CALONDER
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 1:425 PINE RIDGE BOULEVARD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-845-5505
Mailing Address - Fax:
Practice Address - Street 1:425 PINE RIDGE BOULEVARD
Practice Address - Street 2:SUITE 211
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-845-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141389030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
213050002OtherMEDICARE - WISCONSIN
WI44396700Medicaid
WI213050002OtherMEDICARE RAILROAD