Provider Demographics
NPI:1982669412
Name:TOKACH, CRAIG A (CRNA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:TOKACH
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 1:3420 JACKSON DRIVE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-8144
Mailing Address - Country:US
Mailing Address - Phone:920-426-2211
Mailing Address - Fax:920-426-2231
Practice Address - Street 1:3420 JACKSON ST
Practice Address - Street 2:SUITE E
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-8144
Practice Address - Country:US
Practice Address - Phone:920-426-2211
Practice Address - Fax:920-426-2231
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI169-033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1703OtherDEAN HEALTH INSURANCE
WI43308100Medicaid
WI430025795Medicare PIN
WI43308100Medicaid
R40386Medicare UPIN