Healthcare Provider Details

I. General information

NPI: 1689271660
Provider Name (Legal Business Name): ALLISON JUNE WADDING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 10/03/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 7TH ST
FREDERICK MD
21701-4506
US

IV. Provider business mailing address

8691 SATINWOOD DR
FREDERICK MD
21704-5248
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3300
  • Fax:
Mailing address:
  • Phone: 301-873-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number122594
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: