Healthcare Provider Details

I. General information

NPI: 1023493053
Provider Name (Legal Business Name): TIFFANY KUDLAWIEC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY HAMILTON CRNA

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 DRAYSON DR
GALLOWAY OH
43119-8298
US

IV. Provider business mailing address

1059 DRAYSON DR
GALLOWAY OH
43119-8298
US

V. Phone/Fax

Practice location:
  • Phone: 724-554-9551
  • Fax:
Mailing address:
  • Phone: 724-554-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.18197
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number252791
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: