Provider Demographics
NPI:1912175506
Name:WASIELEWSKI, ANTHONY WILLIAM (APRN-BC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:WASIELEWSKI
Suffix:
Gender:M
Credentials:APRN-BC
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Mailing Address - Street 1:1370 MULHOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:NAUVOO
Mailing Address - State:IL
Mailing Address - Zip Code:62354-1010
Mailing Address - Country:US
Mailing Address - Phone:217-453-6802
Mailing Address - Fax:217-453-2149
Practice Address - Street 1:1370 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:NAUVOO
Practice Address - State:IL
Practice Address - Zip Code:62354-1010
Practice Address - Country:US
Practice Address - Phone:217-453-6802
Practice Address - Fax:217-453-2149
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2016-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO151104363LF0000X
IL209013628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500600018Medicare PIN
MO1912175506Medicaid