Provider Demographics
NPI:1043547714
Name:PEREZ, WANDA GARRETT (CRNA)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:GARRETT
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:JEAN
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:150 DREAM DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-2272
Mailing Address - Country:US
Mailing Address - Phone:717-222-0240
Mailing Address - Fax:717-228-1642
Practice Address - Street 1:252 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-7500
Practice Address - Fax:717-228-1642
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN316611L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered