Healthcare Provider Details

I. General information

NPI: 1851715577
Provider Name (Legal Business Name): DUANE G MAYLE JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

PO BOX 715128
COLUMBUS OH
43271-5128
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-5700
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.15170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: