Provider Demographics
NPI:1144246190
Name:LONDEREE, ELFRIEDA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:ELFRIEDA
Middle Name:MARIE
Last Name:LONDEREE
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:OHIO HOSPITAL BASED PHYSICIAN CORP
Mailing Address - Street 2:2600 SIXTH STREET SW
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-363-7462
Mailing Address - Fax:330-363-7679
Practice Address - Street 1:OHIO HOSPITAL BASED PHYSICIAN CORP
Practice Address - Street 2:2600 SIXTH STREET SW
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-7462
Practice Address - Fax:330-363-7679
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN179368367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164950Medicaid
OHLO8220212Medicare PIN