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General NPI Number Information
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NPI Number | 1619991031
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Entity Type | Individual
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Provider Name | SHAWN MICHAEL KOTLYN CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 1414 HONEYGOLD LN
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-3630
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Country | US
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Telephone | 440-570-4022
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 HONEYGOLD LN
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-3630
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Country | US
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Telephone | 440-570-4022
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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 | RN268118 / NA06661
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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 | RN572172
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License Number State | PA
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