Healthcare Provider Details

I. General information

NPI: 1922063379
Provider Name (Legal Business Name): KAREN QUEALY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 QUEEN CITY AVENUE OHIO VALLEY ANETHESIA LLC
CINCINNATI OH
45238
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DRIVE #258 OHIO VALLEY ANESTHESIA LLC
EDGEWOOD KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number152025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: