Healthcare Provider Details

I. General information

NPI: 1619922200
Provider Name (Legal Business Name): ANNA M LANG-CLARK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E STATE STREET
ALLIANCE OH
44601
US

IV. Provider business mailing address

4135 BOARDMAN CANFIELD RD SUITE 101
CANFIELD OH
44406-9803
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6000
  • Fax: 330-596-7214
Mailing address:
  • Phone: 330-286-5330
  • Fax: 330-286-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.187858
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: