Healthcare Provider Details

I. General information

NPI: 1073574976
Provider Name (Legal Business Name): DONNA ELAINE WARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

437 W WASHINGTON ST
LISBON OH
44432-1247
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-3679
  • Fax:
Mailing address:
  • Phone: 330-424-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN154398
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: