Provider Demographics
NPI:1700080199
Name:VANATTA, SYLVIA V (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:V
Last Name:VANATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 BADGER ST
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-1502
Mailing Address - Country:US
Mailing Address - Phone:608-785-8558
Mailing Address - Fax:608-785-8746
Practice Address - Street 1:1300 BADGER ST
Practice Address - Street 2:SUITE 1030
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-1502
Practice Address - Country:US
Practice Address - Phone:608-785-8558
Practice Address - Fax:608-785-8746
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI29881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WID03155Medicare UPIN