Provider Demographics
NPI:1013504034
Name:CICIGOI, LAURA (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CICIGOI
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 1:15136 HILL DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9526
Mailing Address - Country:US
Mailing Address - Phone:440-708-8971
Mailing Address - Fax:
Practice Address - Street 1:2101 ADELBERT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2624
Practice Address - Country:US
Practice Address - Phone:216-844-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH420218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered