Healthcare Provider Details

I. General information

NPI: 1073500633
Provider Name (Legal Business Name): WILLIAM J. WALDRON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL LN
CALAIS ME
04619-1329
US

IV. Provider business mailing address

24 HOSPITAL LN
CALAIS ME
04619-1329
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-7521
  • Fax: 207-454-9247
Mailing address:
  • Phone: 207-454-7521
  • Fax: 207-454-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN320844L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number047978
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA243044
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: