Provider Demographics
NPI:1942606538
Name:CALDWELL, SARAH ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELLEN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELLEN
Other - Last Name:LADRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 632572
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2572
Mailing Address - Country:US
Mailing Address - Phone:859-341-7273
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1111
Practice Address - Fax:513-672-9898
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1141974163W00000X
KY3009245367500000X
OHCOA.17937-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141547Medicaid
OHH415700Medicare PIN