Healthcare Provider Details

I. General information

NPI: 1073735585
Provider Name (Legal Business Name): MICHAEL R. EVERHART CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. ML 2001
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE. ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4408
  • Fax: 513-636-7337
Mailing address:
  • Phone: 513-636-0356
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.08813-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: