Healthcare Provider Details

I. General information

NPI: 1538247770
Provider Name (Legal Business Name): JEFFERY M ABOOD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 23RD ST
CUYAHOGA FALLS OH
44223-1404
US

IV. Provider business mailing address

2908 VINCENT RD
SILVER LAKE OH
44224-2917
US

V. Phone/Fax

Practice location:
  • Phone: 330-971-7123
  • Fax: 330-971-7119
Mailing address:
  • Phone: 330-971-7123
  • Fax: 330-971-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.00590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: