Healthcare Provider Details

I. General information

NPI: 1619921582
Provider Name (Legal Business Name): MARIE A MORELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
YOUNGSTOWN OH
44512-6725
US

IV. Provider business mailing address

4135 BOARDMAN CANFIELD RD SUITE 1
CANFIELD OH
44406-9803
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-2929
  • Fax: 330-286-5396
Mailing address:
  • Phone: 330-286-5330
  • Fax: 330-286-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.00407
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: