Provider Demographics
NPI:1356663686
Name:NADZAM, KIMBERLY RONAE (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RONAE
Last Name:NADZAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RONAE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3622 BELMONT AVE
Mailing Address - Street 2:1
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1450
Mailing Address - Country:US
Mailing Address - Phone:330-759-9350
Mailing Address - Fax:330-759-9387
Practice Address - Street 1:3622 BELMONT AVE
Practice Address - Street 2:1
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1450
Practice Address - Country:US
Practice Address - Phone:330-759-9350
Practice Address - Fax:330-759-9387
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH083420367500000X
OHRN272694367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12105017OtherCAQH
OH3031703Medicaid
OH12105017OtherCAQH