Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 367500000X | Nurse Anesthetist, Certified Registered | | RN-176227 | OHIO | No |
| 2 | 367500000X | Nurse Anesthetist, Certified Registered | | 0024055761 | VIRGINIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 7091249 | MEDICAID | OHIO | |
| 2 | 120811 | OTHER | OHIO | KAISER PERMANENTE INDV # |
| 3 | 34-0891295 | OTHER | OHIO | EMPLOYER FEDERAL TAX ID # |
| 4 | 730618 | OTHER | OHIO | BUCKEYE COMMUNITY HLTH PL |
| 5 | 430005748 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | RAILROAD MEDICARE INDV # |
| 6 | 0751315 | MEDICAID | OHIO | |
| 7 | WI8202981 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | MEDICARE INDV NUMBER |
| 8 | W18202981 | MEDICARE PIN | | |
| 9 | 2080224 | OTHER | OHIO | EMP UNITED HEALTHCARE GRP |
| 10 | 8000281 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | EMPLYR MEDICARE CRNA GRP# |
| 11 | 000000125734 | OTHER | OHIO | ANTHEM BCBS INDV NUMBER |
| 12 | 100153 | OTHER | OHIO | EMPLOYER KAISER GROUP # |
| 13 | CN1092 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | EMPLOYER RR MEDICARE GRP# |
