Healthcare Provider Details

I. General information

NPI: 1720642937
Provider Name (Legal Business Name): JOSEPH BAIERA II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ST LAWRENCE DR
TIFFIN OH
44883-8310
US

IV. Provider business mailing address

3363 TWIN HILLS ST NW
UNIONTOWN OH
44685-8640
US

V. Phone/Fax

Practice location:
  • Phone: 419-455-7000
  • Fax:
Mailing address:
  • Phone: 614-477-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019965
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number335802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: