Provider Demographics
NPI:1952347601
Name:ACKERMAN, CAROL (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ACKERMAN
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:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5724
Mailing Address - Fax:
Practice Address - Street 1:262 NEIL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2362
Practice Address - Country:US
Practice Address - Phone:614-827-6600
Practice Address - Fax:614-827-6690
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN092828367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000268879OtherANTHEM
OH2290515Medicaid
AC8225693Medicare ID - Type Unspecified