Provider Demographics
NPI:1366492175
Name:WARNEMENT, MARK W (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:WARNEMENT
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 1:190 N UNION ST
Mailing Address - Street 2:STE 104
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1369
Mailing Address - Country:US
Mailing Address - Phone:330-253-9145
Mailing Address - Fax:330-253-6222
Practice Address - Street 1:190 N UNION ST
Practice Address - Street 2:STE 104
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1369
Practice Address - Country:US
Practice Address - Phone:330-253-9145
Practice Address - Fax:330-253-6222
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-273852367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH120801OtherKAISER PERMANENTE INDV #
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #
OH7091249Medicaid
OH2080224OtherEMP UNITED HEALTHCARE GRP
OH000000284174OtherANTHEM BCBS INDV NUMBER
OH730613OtherBUCKEYE COMMUNITY HLTH PL
OH2375264Medicaid
OH100153OtherEMPLOYER KAISER GROUP #
OH2080224OtherEMP UNITED HEALTHCARE GRP
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #
OH430079418Medicare ID - Type UnspecifiedRAILROAD MEDICARE INDV #
OH7091249Medicaid