Provider Demographics
NPI:1952655136
Name:DODGE, CHRISTINA E (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:DODGE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:E
Other - Last Name:ZUFELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 535750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5750
Mailing Address - Country:US
Mailing Address - Phone:866-507-5244
Mailing Address - Fax:954-858-1815
Practice Address - Street 1:301 PROSPECT AVE.
Practice Address - Street 2:ANESTHESIA GROUP OF ONONDAGA PC
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-229-5451
Practice Address - Fax:315-229-4710
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533459-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered