Provider Demographics
NPI:1295443828
Name:DREAMWEAVER ANESTHESIA, LLC
Entity type:Organization
Organization Name:DREAMWEAVER ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:336-558-1837
Mailing Address - Street 1:132 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1949
Mailing Address - Country:US
Mailing Address - Phone:608-341-7817
Mailing Address - Fax:
Practice Address - Street 1:132 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1949
Practice Address - Country:US
Practice Address - Phone:608-341-7817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy