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-258973 | OHIO | No |
| 2 | 367500000X | Nurse Anesthetist, Certified Registered | | 733121 | TEXAS | 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 | 34-0891295 | OTHER | OHIO | EMPLOYER FEDERAL TAX ID # |
| 2 | 8000281 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | EMPLYR MEDICARE CRNA GRP# |
| 3 | 120766 | OTHER | OHIO | KAISER PERMANENTE INDV # |
| 4 | 89594U | OTHER | TEXAS | BCBS |
| 5 | 7091249 | MEDICAID | OHIO | |
| 6 | 730559 | OTHER | OHIO | BUCKEYE COMMUNITY HLTH PL |
| 7 | 2080224 | OTHER | OHIO | UNITED HEALTHCARE GROUP # |
| 8 | 2274926 | MEDICAID | OHIO | |
| 9 | 100153 | OTHER | OHIO | EMPLOYER KAISER GROUP # |
| 10 | 000000220486 | OTHER | OHIO | ANTHEM BCBS INDV # |
| 11 | 430070309 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | RAILROAD MEDICARE INDV # |
| 12 | 182095303 | MEDICAID | TEXAS | |
| 13 | 8L9272 | MEDICARE PIN | TEXAS | |
| 14 | CN1092 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | EMPLOYER RR MEDICARE GRP# |
| 15 | HA8229081 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | MEDICARE INDV NUMBER |
