1124185186 NPI number — DANNIELLE PANZETER CRNA

Table of content: DANNIELLE PANZETER CRNA (NPI 1124185186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124185186 NPI number — DANNIELLE PANZETER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANZETER
Provider First Name:
DANNIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUER
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124185186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4877 GOWER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROOTSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44272-9712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-297-0811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 RANDOLPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-327-8105
Provider Business Practice Location Address Fax Number:
828-327-4245
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN260653 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 73778 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000379416 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2622120 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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