Provider Demographics
NPI:1942482906
Name:AHN, AMANDA (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SHAKER
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN295486367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0583328OtherBCMH
OHANTHEMOther000000558101
OHP00471411OtherRAILROAD MEDICARE
OH2821254Medicaid
OH2821254Medicaid