MEDICARE: LUCILLE M STOERKEL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN113670	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000327111	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1386637601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCILLE M STOERKEL CRNA

Provider Business Mailing Address
First Line	:	19250 BAGLEY RD
Second Line	:	#101
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3314
Country	:	US
Telephone Number	:	440-891-8800
Fax Number	:	440-891-1734

Provider Business Practice Location Address
First Line	:	19250 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3314
Country	:	US
Telephone Number	:	440-826-3240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	04/02/2008

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