| Doctor Name: | MR. ANTHONY WILLIAM WASIELEWSKI |
| NPI Number: | 1912175506 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN-BC |
| License Number: | 151104 |
| Business Practice Address: | 1370 Mulholland St Nauvoo, IL - 623541010 |
| Business Phone Number: | 2174536802 |
| Business Fax Number: | 2174532149 |
| Mailing Address: | 1370 Mulholland St, NAUVOO |
| State: | IL |
| Postal Code: | 623541010 |
| Phone Number: | 2174536802 |
| Fax Number: | 2174532149 |
| NPI Enumeration Date: | 02/15/2008 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 151104 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |