Provider Demographics
NPI:1740383876
Name:WADDELL, LOUISE L (CRNA)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:L
Last Name:WADDELL
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:SIXTH AND SPRUCE STREETS
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-6052
Mailing Address - Country:US
Mailing Address - Phone:610-988-5089
Mailing Address - Fax:610-988-5135
Practice Address - Street 1:SIXTH AND SPRUCE STREETS
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19612-6052
Practice Address - Country:US
Practice Address - Phone:610-988-5089
Practice Address - Fax:610-988-5135
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN221921L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered