Provider Demographics
NPI:1487692752
Name:RADWAN, CHARLENE B (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:B
Last Name:RADWAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:B
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1301 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1152
Mailing Address - Country:US
Mailing Address - Phone:724-226-7010
Mailing Address - Fax:724-226-7404
Practice Address - Street 1:1301 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1152
Practice Address - Country:US
Practice Address - Phone:724-226-7010
Practice Address - Fax:724-226-7404
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN284518L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP40408Medicare UPIN
PA067401FFQMedicare ID - Type Unspecified