Healthcare Provider Details

I. General information

NPI: 1427296672
Provider Name (Legal Business Name): DANA M RICHARDSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DRIVE
DAYTON OH
45406-1891
US

IV. Provider business mailing address

3180 KETTERING BLVD
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-2612
  • Fax: 937-567-4163
Mailing address:
  • Phone: 937-297-6072
  • Fax: 937-293-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN306941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: