Provider Demographics
NPI:1497707590
Name:MARIN-REAY, SANDRA L (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MARIN-REAY
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 1:53 NEFF DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1344
Mailing Address - Country:US
Mailing Address - Phone:330-533-4405
Mailing Address - Fax:330-533-4405
Practice Address - Street 1:53 NEFF DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1344
Practice Address - Country:US
Practice Address - Phone:330-533-4405
Practice Address - Fax:330-533-4405
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN120860367500000X
PARN181258L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0762867Medicaid
OHMA8206011Medicare ID - Type Unspecified