Provider Demographics
NPI:1457856635
Name:MOUNTAIN, GREGORY R (APRN-CRNA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:MOUNTAIN
Suffix:
Gender:M
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8487
Mailing Address - Fax:
Practice Address - Street 1:5100 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1672
Practice Address - Country:US
Practice Address - Phone:614-544-2507
Practice Address - Fax:614-544-2384
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019701367500000X
OH019701367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered