Provider Demographics
NPI:1023207230
Name:VICARS, KATHERN SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHERN
Middle Name:SUE
Last Name:VICARS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHERN
Other - Middle Name:SUE
Other - Last Name:PARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MEDICAL STAFF SERVICES ML 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-0356
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:3333 BURNET AVE., ML 2001
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4408
Practice Address - Fax:513-636-7337
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.292628367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered