Healthcare Provider Details

I. General information

NPI: 1992837009
Provider Name (Legal Business Name): ANDREW DAVID MITCHELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET STREET
LIMA OH
45801
US

IV. Provider business mailing address

PO BOX 710776
COLUMBUS OH
43271-0776
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax:
Mailing address:
  • Phone: 419-228-1506
  • Fax: 419-228-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN331022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: