Healthcare Provider Details

I. General information

NPI: 1043547714
Provider Name (Legal Business Name): WANDA GARRETT PEREZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WANDA JEAN ROWE CRNA

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

150 DREAM DR
LEBANON PA
17046-2272
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7500
  • Fax: 717-228-1642
Mailing address:
  • Phone: 717-222-0240
  • Fax: 717-228-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN316611L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: