Provider Demographics
NPI:1407941669
Name:WERESZYNSKI, STEPHEN EDWARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:WERESZYNSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DRIVE SUITE 300
Mailing Address - Street 2:NAPA CORPORATE OFFICE
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-293-9590
Mailing Address - Fax:703-293-9592
Practice Address - Street 1:2501 PARKERS LANE
Practice Address - Street 2:ANESTHESIA DEPT,
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-664-7048
Practice Address - Fax:703-664-7375
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024123260367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK142-0002OtherCARE FIRST 2005
VA1407941669Medicaid
VA139698OtherTRIGON
VA484645OtherNCPPO
VA139698OtherTRIGON
VAK142-0002OtherCARE FIRST 2005