Provider Demographics
NPI:1851385942
Name:CACCHIONE, MICHELLE L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:CACCHIONE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:PRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:5529 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6508
Mailing Address - Country:US
Mailing Address - Phone:440-998-0000
Mailing Address - Fax:440-998-0003
Practice Address - Street 1:2893 N. RIDGE EAST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004
Practice Address - Country:US
Practice Address - Phone:440-998-0000
Practice Address - Fax:440-998-0003
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN310794L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2309997Medicaid
OH2309997Medicaid
OH8237602Medicare PIN
OHH089072Medicare PIN