Provider Demographics
NPI:1982696654
Name:VRESCAK, REBECCA ANN (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:VRESCAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 HAYMAKER RD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3513
Mailing Address - Country:US
Mailing Address - Phone:412-858-4485
Mailing Address - Fax:412-858-3190
Practice Address - Street 1:2570 HAYMAKER RD DEPT OF
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3513
Practice Address - Country:US
Practice Address - Phone:412-858-4485
Practice Address - Fax:412-858-3190
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN280404L367500000X
WV72322367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022465950001Medicaid
PAP00705153Medicare PIN