Healthcare Provider Details

I. General information

NPI: 1942320049
Provider Name (Legal Business Name): LISA M MORICONI RUMELY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RUMELY CRNA

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax:
Mailing address:
  • Phone: 937-641-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.NA06359-NA
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.06359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: