Healthcare Provider Details

I. General information

NPI: 1952351652
Provider Name (Legal Business Name): CYNTHIA M GILLETTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA M PAVIA CRNA

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

4797 BUCKINGHAM DR
BROADVIEW HTS OH
44147-2152
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7052
  • Fax: 330-296-6535
Mailing address:
  • Phone: 216-476-7052
  • Fax: 330-296-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN270580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: