Provider Demographics
NPI:1912153875
Name:MANUEL, JOHN C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:MANUEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1444
Mailing Address - Country:US
Mailing Address - Phone:419-879-3636
Mailing Address - Fax:
Practice Address - Street 1:2793 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806
Practice Address - Country:US
Practice Address - Phone:419-879-3636
Practice Address - Fax:419-879-4312
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH079739367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2890395Medicaid
OH1578745568Medicaid
OHP00682422OtherRAILROAD MEDICARE