Healthcare Provider Details

I. General information

NPI: 1962690362
Provider Name (Legal Business Name): AMY LYNN MARCUCCI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N UNION ST STE 104
AKRON OH
44304-1369
US

IV. Provider business mailing address

190 N UNION ST STE 104
AKRON OH
44304-1327
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-9145
  • Fax: 330-253-6222
Mailing address:
  • Phone: 330-253-9145
  • Fax: 330-253-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number245652
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-282414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: