Provider Demographics
NPI:1427013606
Name:JANITSCHKE, WAYNE BERISFORD JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:BERISFORD
Last Name:JANITSCHKE
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3208 EAGLE RIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-8734
Mailing Address - Country:US
Mailing Address - Phone:320-214-8166
Mailing Address - Fax:
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-235-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR116000-4367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered