Provider Demographics
NPI:1609397280
Name:RAMBO, MAYKA L (DNP-CRNA)
Entity Type:Individual
Prefix:
First Name:MAYKA
Middle Name:L
Last Name:RAMBO
Suffix:
Gender:F
Credentials:DNP-CRNA
Other - Prefix:
Other - First Name:MAYKA
Other - Middle Name:L
Other - Last Name:ARCHULETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5794
Mailing Address - Country:US
Mailing Address - Phone:920-996-3245
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:1405 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2155
Practice Address - Country:US
Practice Address - Phone:920-534-2000
Practice Address - Fax:920-531-2098
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ194168163WC0200X
AZCRNA1430367500000X
WI9904367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine