Provider Demographics
NPI:1912936576
Name:PEREIRA, MADELINE M (CRNA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:M
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:M
Other - Last Name:MACHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E WASHINGTON ST
Mailing Address - Street 2:P O BOX 8031
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5490
Mailing Address - Country:US
Mailing Address - Phone:888-883-8533
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:933 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1730
Practice Address - Country:US
Practice Address - Phone:920-748-3101
Practice Address - Fax:920-406-7675
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91626-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44306900Medicaid
WI44306900Medicaid