MEDICARE: MR. RICHARD WALDEMAR PEDERSEN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP 1449122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326359050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD WALDEMAR PEDERSEN CRNA

Provider Business Mailing Address
First Line	:	2120 N 57TH WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3827
Country	:	US
Telephone Number	:	954-966-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 N 57TH WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3827
Country	:	US
Telephone Number	:	954-966-0721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/02/2011

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