Healthcare Provider Details

I. General information

NPI: 1225441074
Provider Name (Legal Business Name): KATY ROSE QUILTER-CARR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

5100 PREFERRED PL APT. 206
HILLIARD OH
43026-7056
US

V. Phone/Fax

Practice location:
  • Phone: 315-427-2264
  • Fax:
Mailing address:
  • Phone: 315-427-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 401547
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: