Healthcare Provider Details

I. General information

NPI: 1033887518
Provider Name (Legal Business Name): KILEY FRAVEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

5742 VERSAILLES AVE
ANN ARBOR MI
48103-9085
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberPRN.CRNA.0021141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: