Healthcare Provider Details

I. General information

NPI: 1013547496
Provider Name (Legal Business Name): KEVIN WIRES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

2801 TIMBERLINE DR
CORTLAND OH
44410-9275
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6000
  • Fax:
Mailing address:
  • Phone: 330-240-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.020041
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: