=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659726719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER JAMES CUIC CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2016
-----------------------------------------------------
Last Update Date | 04/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1995 E STATE ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44460-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-332-7214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42039 UNION ST
-----------------------------------------------------
City | LISBON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44432-9630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-630-4540
-----------------------------------------------------
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.18996-NA
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------