Provider Demographics
NPI:1952560146
Name:ASSURANCE ANESTHESIA, S.C.
Entity Type:Organization
Organization Name:ASSURANCE ANESTHESIA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUSENBERY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:920-973-4013
Mailing Address - Street 1:3135 PLEASURE POINT DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9190
Mailing Address - Country:US
Mailing Address - Phone:920-973-4013
Mailing Address - Fax:
Practice Address - Street 1:3135 PLEASURE POINT DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-9190
Practice Address - Country:US
Practice Address - Phone:920-973-4013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI030586367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43284700Medicaid
WI43284700Medicaid