Provider Demographics
NPI:1518408087
Name:WALDMAN, BRIAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:WALDMAN
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 1:6040 N OPFER LENTZ RD
Mailing Address - Street 2:
Mailing Address - City:CURTICE
Mailing Address - State:OH
Mailing Address - Zip Code:43412-9656
Mailing Address - Country:US
Mailing Address - Phone:440-241-3969
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.356851367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered