Healthcare Provider Details

I. General information

NPI: 1487621124
Provider Name (Legal Business Name): KAREN SCOTT CIMILLUCA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S GRANT AVE 3RD FL
COLUMBUS OH
43215
US

IV. Provider business mailing address

1299 OLENTANGY RIVER RD STE 103
COLUMBUS OH
43212
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-8808
  • Fax: 614-566-9503
Mailing address:
  • Phone: 614-566-4278
  • Fax: 614-566-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN165554
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA03757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: