Provider Demographics
NPI:1619971041
Name:CAHILL, SUSAN GRACE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GRACE
Last Name:CAHILL
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 1:13523 BARRETT PARKWAY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:636-938-6868
Mailing Address - Fax:636-938-1486
Practice Address - Street 1:5319 HOAG DRIVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1494
Practice Address - Country:US
Practice Address - Phone:440-930-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97506367500000X
OHCOA.01176-NA367500000X
CO097506367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA1197Medicare PIN