Provider Demographics
NPI:1629227509
Name:ARNOLD, BRADLEY D (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:ARNOLD
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 1:2315 SILVER HILL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-6903
Mailing Address - Country:US
Mailing Address - Phone:614-348-4005
Mailing Address - Fax:
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7778
Practice Address - Fax:740-375-8189
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN306417367500000X
OHCOA.10229-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2923626Medicaid
OH2923626Medicaid