Individual
BERNARD WELLICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
575 N RIVER ST, WILKES BARRE, PA 18764-0999
(570) 829-8111
Mailing address
3998 FAIR RDIGE DRIVE, SUITE 300, FAIRFAX, VA 22033
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN284517L
PA
Other
Enumeration date
07/24/2006
Last updated
04/16/2015
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