Healthcare Provider Details

I. General information

NPI: 1053400275
Provider Name (Legal Business Name): GARY A WESSEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 BAY RD SUITE 5B
DOVER DE
19901-4660
US

IV. Provider business mailing address

1175 S STATE ST C O ICARE ANES
DOVER DE
19901-4112
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4688
  • Fax: 302-678-4688
Mailing address:
  • Phone: 302-698-9045
  • Fax: 302-698-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6OA00062
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: