Provider Demographics
NPI:1497314470
Name:WECKER, MATTHEW ALBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALBERT
Last Name:WECKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-0380
Mailing Address - Country:US
Mailing Address - Phone:308-224-2062
Mailing Address - Fax:888-974-5962
Practice Address - Street 1:804 22ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2206
Practice Address - Country:US
Practice Address - Phone:308-440-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101543367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered