MEDICARE: MS. CHRISTINE WACKOWSKI CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	TP003869M	PA
2	225400000X	Rehabilitation Practitioner	TP003869M	PA

General Provider Information

NPI Number	:	1538146584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE WACKOWSKI CRNP

Provider Business Mailing Address
First Line	:	1010 DELAFIELD RD
Second Line	:	BUILDING 50 130G-A
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-1802
Country	:	US
Telephone Number	:	412-822-3134
Fax Number	:	412-822-3019

Provider Business Practice Location Address
First Line	:	1010 DELAFIELD RD
Second Line	:	BUILDING 50 130G-A
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-1802
Country	:	US
Telephone Number	:	412-822-3134
Fax Number	:	412-822-3019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/22/2010

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