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General NPI Number Information
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NPI Number | 1841830916
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Entity Type | Individual
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Provider Name | STACIE RENEE KOBYLANSKI CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 4665 DOUGLAS CIR NW STE 100
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City | CANTON
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State | OH
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Zip | 44718-3673
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Country | US
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Telephone | 330-499-5700
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Fax | 330-498-4229
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Provider Business Mailing Address
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Address Line | 88 WILLOW DR
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City | BOARDMAN
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State | OH
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Zip | 44512-2109
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Country | US
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Telephone | 330-501-5130
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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 | 127185
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License Number State | OH
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