Provider Demographics
NPI:1558891697
Name:WACHENHEIM, MARTHA GRACE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:GRACE
Last Name:WACHENHEIM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:GRACE
Other - Last Name:ZASADNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-0942
Practice Address - Fax:410-550-0443
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253087367500000X
FL9391766367500000X
MDAC003760367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered