=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528010675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN K NORCIA CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 04/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4665 DOUGLAS CIR NW STE 100
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-499-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 W ERIE ST SUITE 203
-----------------------------------------------------
City | PAINESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-3274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-350-0832
-----------------------------------------------------
Fax | 440-354-7420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN266753
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------