Provider Demographics
NPI:1740248079
Name:EDMUNDS, DENA KAY (CRNA, APNP)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:KAY
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:CRNA, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 W RED TAMARACK CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8486
Mailing Address - Country:US
Mailing Address - Phone:816-813-8001
Mailing Address - Fax:
Practice Address - Street 1:855 N WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7668
Practice Address - Country:US
Practice Address - Phone:920-456-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0000129-C-CRNA367500000X
WI8167-33367500000X
MO540657367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO916019417Medicaid
KS100449260BMedicaid
MO269D920Medicare ID - Type Unspecified