Provider Demographics
NPI:1578873105
Name:WEDGE, ROBERT S (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:WEDGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 HARDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-8707
Mailing Address - Country:US
Mailing Address - Phone:231-622-2580
Mailing Address - Fax:
Practice Address - Street 1:825 MOLL DR
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9182
Practice Address - Country:US
Practice Address - Phone:231-497-1031
Practice Address - Fax:231-459-4313
Is Sole Proprietor?:No
Enumeration Date:2010-10-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered