Provider Demographics
NPI:1073500633
Name:WALDRON, WILLIAM J (CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:WALDRON
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 1:24 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1329
Mailing Address - Country:US
Mailing Address - Phone:207-454-7521
Mailing Address - Fax:207-454-9247
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-7521
Practice Address - Fax:207-454-9247
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN320844L163W00000X
PA047978367500000X
MERNA243044367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50003218OtherCAPITAL ADVANTAGE
PA211803000OtherINDEP. BLUE CROSS
PA78003OtherGEISINGER
PA1433520OtherKHP CENTRAL
PA430075687OtherRAIL ROAD MEDICARE
PA1433520OtherHIGHMARK
PA430075687OtherRAIL ROAD MEDICARE
PA50003218OtherCAPITAL ADVANTAGE