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General NPI Number Information
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NPI Number | 1083604250
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Entity Type | Individual
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Provider Name | TODD ALAN WISURI CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2142 N COVE BLVD
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City | TOLEDO
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State | OH
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Zip | 43606-3895
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Country | US
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Telephone | 419-291-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3042
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City | ASHTABULA
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State | OH
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Zip | 44005-3042
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Country | US
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Telephone | 727-324-8844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN223350
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9277359
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License Number State | FL
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