Provider Demographics
NPI:1639776776
Name:WEDOLOWSKI, PATRICK (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:WEDOLOWSKI
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 1:111 W CHESTER AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2809
Mailing Address - Country:US
Mailing Address - Phone:331-642-3566
Mailing Address - Fax:
Practice Address - Street 1:111 W CHESTER AVE APT 2A
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2809
Practice Address - Country:US
Practice Address - Phone:331-642-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000031068367500000X
NC291742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse