Healthcare Provider Details

I. General information

NPI: 1104390830
Provider Name (Legal Business Name): ALLISON E VARGO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KOLBE RD
LORAIN OH
44053-1611
US

IV. Provider business mailing address

27016 BRUCE RD
BAY VILLAGE OH
44140-2211
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-4000
  • Fax:
Mailing address:
  • Phone: 440-897-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberLE-00026351
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: