Provider Demographics
NPI:1003867615
Name:BRAKE, KEVIN N (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:BRAKE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E WATERLOO RD
Mailing Address - Street 2:STE 313
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2721
Practice Address - Street 1:2215 E WATERLOO RD
Practice Address - Street 2:STE 313
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-3856
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:330-208-2721
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN238227367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000185750OtherANTHEM
OH0874782Medicaid
OH13565499OtherCAQH
430059621OtherMEDICARE RAILROAD
OH0874782Medicaid
430059621OtherMEDICARE RAILROAD