Provider Demographics
NPI:1396707394
Name:WETTIG, SCOTT W (CRNA-ACNP)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:WETTIG
Suffix:
Gender:F
Credentials:CRNA-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 USHERS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1427
Mailing Address - Country:US
Mailing Address - Phone:518-221-2521
Mailing Address - Fax:
Practice Address - Street 1:2215 BURDETT AVENUE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3300
Practice Address - Fax:515-525-6545
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526330163W00000X
NYF431089-1363LA2100X
NY526330-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400004803Medicare PIN
NYJ400043798Medicare PIN