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NPI Code Detail

MEDICARE: MR. WAYNE BERISFORD JANITSCHKE JR. CRNA

MEDICARE: MR. WAYNE BERISFORD JANITSCHKE JR. 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
1367500000XCertified Registered Nurse AnesthetistR116000-4MN

General Provider Information

NPI Number : 1427013606
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WAYNE BERISFORD JANITSCHKE JR. CRNA
Provider Business Mailing Address
First Line : 3208 EAGLE RIDGE DR E
Second Line :
City : WILLMAR
State : MN
Zip : 56201-8734
Country : US
Telephone Number : 320-214-8166
Fax Number :
Provider Business Practice Location Address
First Line : 301 BECKER AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-3302
Country : US
Telephone Number : 320-235-4543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 09/02/2014

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