=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568437580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT P SZEWCZYK CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 01/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1997 MIAMISBURG CENTERVILLE RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-439-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1374 WILD IVY WAY
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45440-4099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-694-5964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | NA-08333
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------