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General NPI Number Information
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NPI Number | 1962440255
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Entity Type | Individual
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Provider Name | JOHN WESOLOWSKI C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 289 HICKORY RIDGE DR
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City | QUEENSTOWN
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State | MD
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Zip | 21658-1392
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Country | US
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Telephone | 410-340-3705
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Fax | 410-827-7673
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Provider Business Mailing Address
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Address Line | PO BOX 609
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City | LAUREL
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State | MD
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Zip | 20725-0609
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Country | US
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Telephone | 410-340-3705
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Fax | 410-827-7673
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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 | R078019
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License Number State | MD
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