Provider Demographics
NPI:1083624886
Name:ANSELM, ROBIN LEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LEE
Last Name:ANSELM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:LEE
Other - Last Name:GROVES ANSELM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:OH
Mailing Address - Zip Code:44210-0335
Mailing Address - Country:US
Mailing Address - Phone:330-472-5249
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DD40
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:330-472-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45193367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107780Medicaid
OH0107780Medicaid