Provider Demographics
NPI:1982786018
Name:CARDWELL, DAVID W (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:CARDWELL
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 1:121 LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3416
Mailing Address - Country:US
Mailing Address - Phone:740-591-8213
Mailing Address - Fax:
Practice Address - Street 1:121 LOUISE LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3416
Practice Address - Country:US
Practice Address - Phone:740-591-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10087.NA367500000X
FLAPRN11000465367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2924358Medicaid
WV3810025067Medicaid
OHH159791Medicare PIN
OHCA8243101Medicare PIN