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NPI Code Detail

MEDICARE: MS. BETH EILEEN SHEPARD DUTRO CRNA

MEDICARE: MS. BETH EILEEN SHEPARD DUTRO CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN.CRNA.02487OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1430039229OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487652301
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETH EILEEN SHEPARD DUTRO CRNA
Provider Business Mailing Address
First Line : PO BOX 932759
Second Line :
City : CLEVELAND
State : OH
Zip : 44193-0015
Country : US
Telephone Number : 937-293-8228
Fax Number : 937-293-8229
Provider Business Practice Location Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-293-8228
Fax Number : 937-293-8229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 09/03/2020

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