Individual
JUSTIN WANINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3700 S MAIN ST, BLACKSBURG, VA 24060-7017
(540) 951-1111
Mailing address
1838 CARLETON DR, SALEM, VA 24153
(812) 630-0100
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
0001275299
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024180835
VA
Other
Enumeration date
11/24/2020
Last updated
01/22/2021
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