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  7. NPI Record 1497261333

ERIC MICHAEL LEE CRNA
Complete NPI Record 1497261333
Nurse Anesthetist, Certified Registered in Weston, WI

NPI Status: Active since December 14, 2017

Contact Information

3400 MINISTRY PKWY
WESTON, WI
ZIP 54476
Phone: (715) 393-3000

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Provider Gender Code
  22. Healthcare Provider Taxonomy Code 1
  23. Provider License Number 1
  24. Provider License Number State Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Is Sole Proprietor
  27. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1497261333. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1497261333
The State code in the location of the provider being identified.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: ERIC
The first name of the provider, if the provider is an individual.
Provider Middle Name: MICHAEL
The middle name of the provider, if the provider is an individual.
Provider Credential Text: CRNA
The date the provider was assigned a unique identifier (assigned an NPI).
Provider First Line Business Mailing Address: 3400 MINISTRY PKWY
The date that a record was last updated or changed.
Provider Business Mailing Address City Name: WESTON
The code designating the provider’s gender if the provider is a person.
Provider Business Mailing Address State Name: WI
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Business Mailing Address Postal Code: 544765220
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address Country Code If outside U S : US
The city name in the location address of the provider being identified.
Provider Business Mailing Address Telephone Number: 7153933000
The State code in the location of the provider being identified.
Provider First Line Business Practice Location Address: 3400 MINISTRY PKWY
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WESTON
The country code in the location address of the provider being identified.
Provider Business Practice Location Address State Name: WI
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 544765220
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address Country Code If outside U S : US
The date that a record was last updated or changed.
Provider Business Practice Location Address Telephone Number: 7153933000
The code designating the provider’s gender if the provider is a person.
Provider Enumeration Date: 12/14/2017
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/10/2024
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Gender Code: M
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Taxonomy Code 1: 367500000X
Provider License Number 1: 172071
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Provider License Number State Code 1: WI
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
NPI Certification Date: 4/10/2024