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General NPI Number Information
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NPI Number | 1891778510
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Entity Type | Individual
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Provider Name | DONALD WAYNE ANDERSON JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 22 S GREENE ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1544
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Country | US
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Telephone | 410-328-6704
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Fax | 410-328-4124
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Provider Business Mailing Address
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Address Line | 809 TYLER AVE
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City | ANNAPOLIS
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State | MD
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Zip | 21403-2805
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Country | US
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Telephone | 443-610-3257
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Fax | 443-610-3257
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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 | R107354
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License Number State | MD
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