Healthcare Provider Details

I. General information

NPI: 1235687161
Provider Name (Legal Business Name): MARISSA ROKICKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 EMBASSY PKWY SUITE 202
AKRON OH
44333-8320
US

IV. Provider business mailing address

6225 STATE HWY 161 STE 200
IRVING TX
75038-2223
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: