Provider Demographics
NPI:1134112006
Name:DAVIS, ANN MARIE (CRNA, MSN)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19250 BAGLEY RD
Mailing Address - Street 2:#101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3314
Mailing Address - Country:US
Mailing Address - Phone:440-891-8800
Mailing Address - Fax:440-891-1734
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5293
Practice Address - Country:US
Practice Address - Phone:440-827-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN179079367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000241416OtherANTHEM BCBS
OH0768423Medicaid
OH430075902OtherRAILROAD MEDICARE
OHDA8215493Medicare ID - Type Unspecified