Individual
GARY L WALDRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
320 LORETTO RD, LEBANON, KY 40033-1300
(270) 692-3161
Mailing address
328 PARKWOOD DR, CAMPBELLSVILLE, KY 42718-9693
(270) 789-3766
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1061368
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74280710
—
KY
Enumeration date
05/02/2006
Last updated
05/07/2014
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