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General NPI Number Information
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NPI Number | 1902886187
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Entity Type | Individual
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Provider Name | JANET WALLECK CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | WVU HOSP 1 MEDICAL DRIVE
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City | MORGANTOWN
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State | WV
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Zip | 26506
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Country | US
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Telephone | 304-598-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 303 MUNNELL STREET
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City | CANONSBURG
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State | PA
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Zip | 15317
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Country | US
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Telephone | 724-809-4033
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Fax |
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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 | RN328553L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 60816
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License Number State | WV
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