Provider Demographics
NPI:1518781962
Name:WASCZENSKI, CHARLES ALEXANDER (RN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:WASCZENSKI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5209
Mailing Address - Country:US
Mailing Address - Phone:702-251-3854
Mailing Address - Fax:
Practice Address - Street 1:2950 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5209
Practice Address - Country:US
Practice Address - Phone:702-251-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV884344163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health