Basic Information
| Provider Information | |||||||||
| NPI: | 1427013606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANITSCHKE | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | BERISFORD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3208 EAGLE RIDGE DR E | ||||||||
| Address2: | |||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562018734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202148166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 BECKER AVE SW | ||||||||
| Address2: | |||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562013302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202354543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R116000-4 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.