Healthcare Provider Details

I. General information

NPI: 1992368245
Provider Name (Legal Business Name): DUANE ANDREW BURTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 STATE RD
CINCINNATI OH
45255-2439
US

IV. Provider business mailing address

1222 FUHRMAN RD
CINCINNATI OH
45215-4002
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-4500
  • Fax:
Mailing address:
  • Phone: 513-633-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number377658
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: