Provider Demographics
NPI:1962440255
Name:WESOLOWSKI, JOHN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WESOLOWSKI
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:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725-0609
Mailing Address - Country:US
Mailing Address - Phone:410-340-3705
Mailing Address - Fax:410-827-7673
Practice Address - Street 1:289 HICKORY RIDGE DR
Practice Address - Street 2:
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658-1392
Practice Address - Country:US
Practice Address - Phone:410-340-3705
Practice Address - Fax:410-827-7673
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR078019367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNA96OtherCARE FIRST BC/BS
DCK230OtherCARE FIRST BC/BS
P00099944OtherRAILROAD MEDICARE
DCK230OtherCARE FIRST BC/BS
MDR13091Medicare UPIN