Healthcare Provider Details

I. General information

NPI: 1265971444
Provider Name (Legal Business Name): ANDREW ROBERTS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

15725 VAN AKEN BLVD #9
SHAKER HEIGHTS OH
44120-5375
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-2900
  • Fax:
Mailing address:
  • Phone: 616-822-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number112854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: