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General NPI Number Information
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NPI Number | 1528115003
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Entity Type | Individual
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Provider Name | MARIE H. RODSTROM CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 18101 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-5612
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Country | US
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Telephone | 216-476-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 21232 N PARK DR
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2318
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Country | US
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Telephone | 440-356-5375
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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 | RN235080
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License Number State | OH
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