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NPI Code Detail

MEDICARE: ELEANOR J MCKENZIE CRNA

MEDICARE: ELEANOR J MCKENZIE 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 AnesthetistRN210273LPA
2163W00000XRegistered NurseRN-112502OH
3367500000XCertified Registered Nurse AnesthetistCOA.02695-NAOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699721563
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELEANOR J MCKENZIE CRNA
Provider Business Mailing Address
First Line : 3622 BELMONT AVE
Second Line : SUITE 1
City : YOUNGSTOWN
State : OH
Zip : 44505-1450
Country : US
Telephone Number : 330-759-9350
Fax Number : 330-759-9387
Provider Business Practice Location Address
First Line : 1995 E STATE ST
Second Line :
City : SALEM
State : OH
Zip : 44460-2423
Country : US
Telephone Number : 330-332-1551
Fax Number : 330-332-7663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 03/17/2011

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Directions to “ ELEANOR J MCKENZIE CRNA” Practice Location

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