Provider Demographics
NPI:1952556664
Name:ZHOVTIS, EDWARD (CRNA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ZHOVTIS
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 1:711 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5052
Mailing Address - Country:US
Mailing Address - Phone:715-284-5361
Mailing Address - Fax:715-284-3684
Practice Address - Street 1:711 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5052
Practice Address - Country:US
Practice Address - Phone:715-284-5361
Practice Address - Fax:715-284-3684
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007347367500000X
WI7283367500000X
MN1948367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
593490018Medicare Oscar/Certification