Healthcare Provider Details

I. General information

NPI: 1730121948
Provider Name (Legal Business Name): ANNETTE F. GILL MSN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MEDINA OH
44256
US

IV. Provider business mailing address

2344 CHAMPION TRAIL
TWINSBURG OH
44087-3210
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-1000
  • Fax:
Mailing address:
  • Phone: 330-487-1833
  • Fax: 330-487-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN560340
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.03806
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: