Provider Demographics
NPI:1679535868
Name:BOATRIGHT, LONNIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:BOATRIGHT
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 1:2600 SIXTH ST SW
Mailing Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORPORATION
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-363-7462
Mailing Address - Fax:330-363-7679
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORPORATION
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-7462
Practice Address - Fax:330-363-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN146923367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0790078Medicaid
OHBO8200673Medicare PIN