Healthcare Provider Details

I. General information

NPI: 1649206368
Provider Name (Legal Business Name): LAURENE M KIEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E STATE ST
ALLIANCE OH
44601-4936
US

IV. Provider business mailing address

200 EAST STATE STREET
ALLIANCE OH
44601-4936
US

V. Phone/Fax

Practice location:
  • Phone: 330-829-4000
  • Fax: 330-829-4533
Mailing address:
  • Phone: 330-596-6000
  • Fax: 330-596-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA04132NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: