Provider Demographics
NPI:1619922200
Name:LANG-CLARK, ANNA M (CRNA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:LANG-CLARK
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
Mailing Address - Street 2:SUITE 101
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 STREET
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:330-596-6000
Practice Address - Fax:330-596-7214
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.187858367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000672398OtherANTHEM
OH0768692Medicaid
OHP00954616OtherRRMCR
WV3810018495Medicaid
OH000000666673OtherANTHEM
OHLA8204312Medicare ID - Type Unspecified
OH8244333Medicare PIN
OH000000672398OtherANTHEM