Provider Demographics
NPI:1558358945
Name:CROGNALE, KATHLEEN D (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:D
Last Name:CROGNALE
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 1:3878 WOODBURY OVAL
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5485
Mailing Address - Country:US
Mailing Address - Phone:330-686-7720
Mailing Address - Fax:
Practice Address - Street 1:4441 HUDSON DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2218
Practice Address - Country:US
Practice Address - Phone:330-920-4500
Practice Address - Fax:330-920-4501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN109933367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CR8208395Medicare ID - Type Unspecified