Provider Demographics
NPI:1275951063
Name:ROUHANA, ADLA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ADLA
Middle Name:
Last Name:ROUHANA
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 1:500 OLD LANE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3529
Mailing Address - Country:US
Mailing Address - Phone:607-725-8085
Mailing Address - Fax:
Practice Address - Street 1:500 OLD LANE RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3529
Practice Address - Country:US
Practice Address - Phone:607-725-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101531367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered