Provider Demographics
NPI:1275690067
Name:VASEY, IAN J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:J
Last Name:VASEY
Suffix:
Gender:M
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:PO BOX 640929
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0929
Mailing Address - Country:US
Mailing Address - Phone:513-727-0748
Mailing Address - Fax:
Practice Address - Street 1:105 MCKNIGHT DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4898
Practice Address - Country:US
Practice Address - Phone:513-424-2111
Practice Address - Fax:513-420-5662
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN296712367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered