Healthcare Provider Details

I. General information

NPI: 1144287095
Provider Name (Legal Business Name): TAMARA E. KOLODZIK-KAYE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CHILDREN'S PLAZA CHILDREN'S ANESTHESIA GROUP, INC.
DAYTON OH
45404-1815
US

IV. Provider business mailing address

ONE CHILDREN'S PLAZA CHILDREN'S ANESTHESIA GROUP, INC.
DAYTON OH
45404-1815
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3350
  • Fax: 937-641-6145
Mailing address:
  • Phone: 937-641-3350
  • Fax: 937-641-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.03206-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: