Healthcare Provider Details

I. General information

NPI: 1184067118
Provider Name (Legal Business Name): KATIE E DURACKY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ARLINGTON AVE
TOLEDO OH
43614-2595
US

IV. Provider business mailing address

3355 GLENDALE AVE 3RD FL
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-3556
  • Fax: 419-383-3550
Mailing address:
  • Phone: 419-383-5322
  • Fax: 419-383-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.14184-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: