Healthcare Provider Details

I. General information

NPI: 1891050977
Provider Name (Legal Business Name): KAITLIN VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN BARRINGER CRNA

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE N429, DOAN HALL
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

410 W 10TH AVE N429, DOAN HALL
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-4705
  • Fax: 614-293-8153
Mailing address:
  • Phone: 614-293-4705
  • Fax: 614-293-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN. 343239
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.13931
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: