Healthcare Provider Details

I. General information

NPI: 1356399158
Provider Name (Legal Business Name): SHARON IRVING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

IV. Provider business mailing address

121 W HIGH ST FIFTH FLOOR
LIMA OH
45801-4308
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3335
  • Fax:
Mailing address:
  • Phone: 419-226-5197
  • Fax: 419-998-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN110813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: