Provider Demographics
NPI:1962476564
Name:PAVLICH, ROSEMARY (CRNA)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:PAVLICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:330-596-7227
Practice Address - Fax:330-286-5396
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN128393367500000X
PARN312752L367500000X
OHNA-02490367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA29408OtherCRNA CERTIFICATE
OH0758434Medicaid
PA29408OtherCRNA CERTIFICATE
OH0758434Medicaid
OHPA8206188Medicare Oscar/Certification