Provider Demographics
NPI:1932212974
Name:CAMERON, SHIRLEY L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:L
Last Name:CAMERON
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 1:3500 COOK RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9233
Mailing Address - Country:US
Mailing Address - Phone:330-723-7907
Mailing Address - Fax:
Practice Address - Street 1:860 E BROAD ST
Practice Address - Street 2:SUITE I
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6542
Practice Address - Country:US
Practice Address - Phone:440-323-8458
Practice Address - Fax:440-323-7900
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143304367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776352Medicaid
OH8125092Medicare ID - Type Unspecified