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Individual

CALVIN WIENTJES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
4568 QUAIL HOLLOW DR, PADUCAH, KY 42001-5396
(618) 638-3656
Mailing address
4568 QUAIL HOLLOW DR, PADUCAH, KY 42001-5396
(618) 638-3656

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.446613
IL
163W00000X
Registered Nurse
199315
TN
163W00000X
Registered Nurse
416443
OH
367500000X
Certified Registered Nurse Anesthetist
209.015519
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
3010948
KY

Other

Enumeration date
12/06/2016
Last updated
03/31/2022
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