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-171836 | OHIO | 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 | CN1092 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | EMPLOYER RR MEDICARE GRP# |
| 2 | 7091249 | MEDICAID | OHIO | |
| 3 | 000000125775 | OTHER | OHIO | ANTHEM BCBS INDV NUMBER |
| 4 | SA8202901 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | MEDICARE INDV NUMBER |
| 5 | 8000281 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | EMPLYR MEDICARE CRNA GRP# |
| 6 | 2080224 | OTHER | OHIO | EMP UNITED HEALTHCARE GRP |
| 7 | 0751388 | MEDICAID | OHIO | |
| 8 | 730604 | OTHER | OHIO | BUCKEYE COMMUNITY HLTH PL |
| 9 | 100153 | OTHER | OHIO | EMPLOYER KAISER GROUP # |
| 10 | 120792 | OTHER | OHIO | KAISER PERMANENTE INDV # |
