Provider Demographics
NPI:1528035987
Name:VESELY, REBECCA E (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:VESELY
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 1:125 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5958
Mailing Address - Country:US
Mailing Address - Phone:724-837-7215
Mailing Address - Fax:
Practice Address - Street 1:112 N. SEVENTH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-267-3000
Practice Address - Fax:717-217-4217
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-182304-L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050514OtherMEDICARE GROUP #
PARN182304LOtherLICENSE