Healthcare Provider Details

I. General information

NPI: 1134192545
Provider Name (Legal Business Name): DEBRA LYNN CORELLA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JOHNSON RD
STEUBENVILLE OH
43952-2364
US

IV. Provider business mailing address

116 OLIVE DR
WINTERSVILLE OH
43953-4253
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-8000
  • Fax:
Mailing address:
  • Phone: 740-264-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number50285
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN270610L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: