Healthcare Provider Details

I. General information

NPI: 1861933517
Provider Name (Legal Business Name): JOEL WADKINS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2358
US

IV. Provider business mailing address

31 CAMI WAY
ELKTON MD
21921-7308
US

V. Phone/Fax

Practice location:
  • Phone: 516-370-3628
  • Fax:
Mailing address:
  • Phone: 410-441-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00784
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: