Provider Demographics
NPI:1881650257
Name:WIECZOREK, LAWRENCE WAYNE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:WIECZOREK
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 1:32 POST OAK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONS GAP
Mailing Address - State:AL
Mailing Address - Zip Code:36861-2545
Mailing Address - Country:US
Mailing Address - Phone:251-769-1900
Mailing Address - Fax:
Practice Address - Street 1:32 POST OAK LN
Practice Address - Street 2:
Practice Address - City:JACKSONS GAP
Practice Address - State:AL
Practice Address - Zip Code:36861-2545
Practice Address - Country:US
Practice Address - Phone:251-769-1900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064713367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered