Healthcare Provider Details

I. General information

NPI: 1669587911
Provider Name (Legal Business Name): ARLENE G AGRA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 EAST BROAD STREET SUITE I
ELYRIA OH
44035
US

IV. Provider business mailing address

36151 GRAFTON EASTERN RD
GRAFTON OH
44044-9637
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-8458
  • Fax: 440-323-7900
Mailing address:
  • Phone: 216-870-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number203557
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: