=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962463067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES WASNIESKI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 E NORTH AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-3155
-----------------------------------------------------
Fax | 412-359-3483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 RIDGEWOOD RD SUITE 200, CWING
-----------------------------------------------------
City | MOON TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15108-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN100134CRNA
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN526996L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------