Organization
SANDUSKY BAY ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT S WISNIEWSKI C.R.N.A. (PRESIDENT)
(918) 543-1020
Entity
Organization
Contact information
Practice address
1101 DECATUR ST, SANDUSKY, OH 44870-3335
(918) 543-1020
(918) 543-2103
Mailing address
PO BOX 190, INOLA, OK 74036-0190
(918) 543-1020
(918) 543-2103
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2312492
—
OH
Enumeration date
08/05/2006
Last updated
08/22/2020
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