Healthcare Provider Details

I. General information

NPI: 1356626246
Provider Name (Legal Business Name): KATRINA LUCILLE PINCZES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RED ROCK DR
GALLUP NM
87301-5683
US

IV. Provider business mailing address

391 WARWICK ST
AKRON OH
44305-3129
US

V. Phone/Fax

Practice location:
  • Phone: 330-603-5716
  • Fax:
Mailing address:
  • Phone: 330-794-8871
  • Fax: 330-794-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12236-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: