Healthcare Provider Details

I. General information

NPI: 1841206612
Provider Name (Legal Business Name): MICHAEL ROUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

3200 BURNET AVE 3 SOUTH
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-7388
  • Fax: 513-872-7385
Mailing address:
  • Phone: 513-585-5503
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRNCRNA06816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: