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General NPI Number Information
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NPI Number | 1053400275
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Entity Type | Individual
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Provider Name | GARY A WESSEL CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 655 BAY RD SUITE 5B
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City | DOVER
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State | DE
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Zip | 19901-4660
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Country | US
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Telephone | 302-678-4688
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Fax | 302-678-4688
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Provider Business Mailing Address
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Address Line | 1175 S STATE ST C O ICARE ANES
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City | DOVER
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State | DE
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Zip | 19901-4112
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Country | US
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Telephone | 302-698-9045
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Fax | 302-698-9045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | L6OA00062
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License Number State | DE
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