Provider Demographics
NPI:1427218825
Name:SEWECKE, ANGELA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:SEWECKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-231-6550
Practice Address - Fax:412-231-6697
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN342556L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
12184979OtherCAQH
PA0019421200001Medicaid
PA016536TV6Medicare PIN