Healthcare Provider Details

I. General information

NPI: 1013458322
Provider Name (Legal Business Name): GREGORY HALSTEAD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

IV. Provider business mailing address

6225 N STATE HIGHWAY 161 SUITE 200
IRVING TX
75038-2223
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-4524
  • Fax: 419-245-6018
Mailing address:
  • Phone: 214-687-0497
  • Fax: 214-687-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: