Healthcare Provider Details

I. General information

NPI: 1326516527
Provider Name (Legal Business Name): TRACI CASTELLI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 01/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

893 KLONDYKE RD
MILFORD OH
45150-9684
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax: 513-672-9898
Mailing address:
  • Phone: 513-267-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019807
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: