Provider Demographics
NPI:1669486387
Name:MAULORICO, JOHANNA (CRNA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:MAULORICO
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 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN217978367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221166OtherUNISON
OH000000515997OtherANTHEM
OH0583328OtherBCMH
OH430050956OtherRAILROAD MEDICARE
OH2306034Medicaid
OH415008OtherWELLCARE MEDICAID
OH750905OtherBUCKEYE MEDICAID
OH7960351OtherAETNA
OHP00405855OtherMEDICARE RAILROAD
OHMA8223943Medicare PIN
OHMA7260031Medicare PIN