Individual
JOHN F WELLBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 MEDICAL VILLAGE DR, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
PO BOX 12749, COVINGTON, KY 41012-0749
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1064906
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
038780
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000229614
ANTHEM BLUE SHIELD
—
05
—
0807023
—
OH
05
—
74387804
—
KY
Enumeration date
12/21/2005
Last updated
04/01/2008
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