Healthcare Provider Details

I. General information

NPI: 1083671879
Provider Name (Legal Business Name): KATHIE IRENE GENGLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 N DIXIE HWY
TROY OH
45373-1337
US

IV. Provider business mailing address

3366 RIVERSIDE DRIVE SUITE 200
COLUMBUS OH
43221
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-7830
  • Fax: 614-459-7824
Mailing address:
  • Phone: 614-459-7830
  • Fax: 614-459-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN220335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: