Provider Demographics
NPI:1538146584
Name:WACKOWSKI, CHRISTINE (CRNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:WACKOWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 DELAFIELD RD
Mailing Address - Street 2:BUILDING 50 130G-A
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1802
Mailing Address - Country:US
Mailing Address - Phone:412-822-3134
Mailing Address - Fax:412-822-3019
Practice Address - Street 1:1010 DELAFIELD RD
Practice Address - Street 2:BUILDING 50 130G-A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-1802
Practice Address - Country:US
Practice Address - Phone:412-822-3134
Practice Address - Fax:412-822-3019
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003869M363LA2200X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044770T2MMedicare ID - Type Unspecified
PAP22602Medicare UPIN