Healthcare Provider Details

I. General information

NPI: 1922288786
Provider Name (Legal Business Name): JARMILA HUDSPATH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

4135 BOARDMAN-CANFIELD ROAD SUITE 101
CANFIELD OH
44406-7010
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-5330
  • 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 NumberRN305884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: