Individual
JANET WALLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
60816
WV
367500000X
Certified Registered Nurse Anesthetist
RN328553L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018886610009
—
PA
05
—
2321991
—
OH
05
—
2605199000
—
WV
01
—
P00384420
RAILROAD MEDICARE
—
Enumeration date
01/23/2006
Last updated
12/12/2007
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