Provider Demographics
NPI:1063477842
Name:KEMPEN, AGINA M (CRNA)
Entity Type:Individual
Prefix:
First Name:AGINA
Middle Name:M
Last Name:KEMPEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AGINA
Other - Middle Name:M
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:340 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3412
Mailing Address - Country:US
Mailing Address - Phone:412-860-1976
Mailing Address - Fax:
Practice Address - Street 1:340 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3412
Practice Address - Country:US
Practice Address - Phone:412-860-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 245303367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S43175Medicare UPIN