Provider Demographics
NPI:1891788923
Name:DOUGLAS, BARBARA M (CRNA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:M
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11991 TAYLOR WELLS RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-7900
Mailing Address - Country:US
Mailing Address - Phone:440-724-0722
Mailing Address - Fax:440-635-0046
Practice Address - Street 1:11991 TAYLOR WELLS RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7900
Practice Address - Country:US
Practice Address - Phone:440-724-0722
Practice Address - Fax:440-635-0046
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053843Medicaid