=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609810100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSTANCE M COX CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 05/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 SYLVANIA DR
-----------------------------------------------------
City | BEAVERCREEK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45440-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-320-5050
-----------------------------------------------------
Fax | 937-320-5060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1859 LIBERTY RD
-----------------------------------------------------
City | NEW CARLISLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45344-8527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-308-5407
-----------------------------------------------------
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 | COA.07366-NA
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------