Provider Demographics
NPI:1700160926
Name:GAJDOSTIK, BETH ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:GAJDOSTIK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2914 S REPUBLIC BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1912
Mailing Address - Country:US
Mailing Address - Phone:419-531-8808
Mailing Address - Fax:419-531-8877
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-531-8808
Practice Address - Fax:419-531-8877
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.240300-COA1163W00000X
OHCOA. 12751-NA367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No163W00000XNursing Service ProvidersRegistered Nurse