Provider Demographics
NPI:1578848388
Name:KNIRSCH, STACIE ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:ANN
Last Name:KNIRSCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:860 EAST BROAD STREET
Mailing Address - Street 2:SUITE I
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6542
Mailing Address - Country:US
Mailing Address - Phone:440-323-8458
Mailing Address - Fax:440-323-7900
Practice Address - Street 1:630 EAST RIVER STREET
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-329-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.301737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered