Provider Demographics
NPI:1356358469
Name:WASSERMAN, VICTORIA ANN (CRNA, APRN)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, APRN
Mailing Address - Street 1:345 N MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2515
Mailing Address - Country:US
Mailing Address - Phone:860-231-1111
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-231-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE47444163W00000X
MA244551367500000X
CT000417367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse