Healthcare Provider Details

I. General information

NPI: 1720190952
Provider Name (Legal Business Name): ANGELA D HITCHCOCK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N POPLAR ST MCCULLOUGH-HYDE MEMORIAL HOSPITAL ANESTHESIA DEPT
OXFORD OH
45056-1204
US

IV. Provider business mailing address

PO BOX 20452
COLUMBUS OH
43220-0452
US

V. Phone/Fax

Practice location:
  • Phone: 513-524-5574
  • Fax: 513-524-5559
Mailing address:
  • Phone: 614-442-2406
  • Fax: 614-442-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN242301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: