Healthcare Provider Details

I. General information

NPI: 1750979407
Provider Name (Legal Business Name): SCOTT MICHAEL ELLIOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 BENEDICT AVE
NORWALK OH
44857-2374
US

IV. Provider business mailing address

33751 VIA SAN ANGELO DR
AVON OH
44011-3731
US

V. Phone/Fax

Practice location:
  • Phone: 440-781-9318
  • Fax:
Mailing address:
  • Phone: 440-781-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0020214
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: