Provider Demographics
NPI:1922097351
Name:SILBERNAGEL, THOMAS ROYCE (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROYCE
Last Name:SILBERNAGEL
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:N3708 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-7218
Mailing Address - Country:US
Mailing Address - Phone:715-819-8353
Mailing Address - Fax:
Practice Address - Street 1:N3708 RIVER AVE
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-7218
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:715-743-6245
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1866-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43409000Medicaid
WI43409000Medicaid