Healthcare Provider Details

I. General information

NPI: 1962891671
Provider Name (Legal Business Name): RACHEL ANN VANDERWYST CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

190 N UNION ST SUITE 104
AKRON OH
44304-1369
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 TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN339315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: