Healthcare Provider Details

I. General information

NPI: 1104821636
Provider Name (Legal Business Name): ELIZABETH ODDI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CICCOLINI CRNA

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

224 W EXCHANGE ST STE 220
AKRON OH
44302-1704
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6000
  • Fax:
Mailing address:
  • Phone: 330-344-7040
  • Fax: 330-344-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 146980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: