Provider Demographics
NPI:1124024484
Name:ANDRUS, JERI (CRNA)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:STE 360
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1715
Mailing Address - Country:US
Mailing Address - Phone:330-344-6401
Mailing Address - Fax:330-344-1714
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.259953367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2071636Medicaid
OH000000221850OtherANTHEM PIN#
OH430058352OtherTRAVELERS PIN#
OH430058352OtherTRAVELERS PIN#