Provider Demographics
NPI:1568546695
Name:DOBOS, TRACY LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:DOBOS
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 1:190 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:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-212961367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0008463850OtherEMPLOYER AETNA GRP NUMBER
OHNA-09141OtherCRNA OH BOARD OF NURSING
OH1770547408OtherEMPLOYER ORG NPI NUMBER
OHRN-212961OtherRN LICENSE NUMBER
OH7091249Medicaid
OH076189OtherCCNA NUMBER
OH7091249Medicaid
OH1770547408OtherEMPLOYER ORG NPI NUMBER