Provider Demographics
NPI:1649254541
Name:VOLK, KRISTA L (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:VOLK
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 1:1200 RALSTON AVE
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-1396
Mailing Address - Country:US
Mailing Address - Phone:419-783-6944
Mailing Address - Fax:419-786-4416
Practice Address - Street 1:1200 RALSTON AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1396
Practice Address - Country:US
Practice Address - Phone:419-783-6944
Practice Address - Fax:419-786-4416
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.248721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000368809OtherANTHEM
OH2239689Medicaid
OH2758885600-00OtherBWC
P00420419OtherRRMC
OH000000368809OtherANTHEM