Healthcare Provider Details

I. General information

NPI: 1891066601
Provider Name (Legal Business Name): KRISTINA PARR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA GALLO CRNA

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

IV. Provider business mailing address

PO BOX 947
CHAMBERSBURG PA
17201-0947
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax: 717-263-1566
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.13097-NA
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.333162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: