Healthcare Provider Details

I. General information

NPI: 1396185302
Provider Name (Legal Business Name): CARRIE JEAN WISLER C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE SCHLOSS

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1815
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3477
  • Fax: 937-641-5410
Mailing address:
  • Phone: 937-641-3477
  • Fax: 937-641-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberAPRN.CRNA.14588
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: