Provider Demographics
NPI:1366744138
Name:LICHTENSTEIN, SONYA JOLINE (CRNA)
Entity type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:JOLINE
Last Name:LICHTENSTEIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:SONYA
Other - Middle Name:JOLINE
Other - Last Name:LICHTENSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:15 ARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2400
Mailing Address - Country:US
Mailing Address - Phone:859-816-4824
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL VILLAGE DR STE 258
Practice Address - Street 2:ST. ELIZABETH HOSPITAL
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY85927367500000X
KY1118077163W00000X
OH325071163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201009550Medicaid
000000698683OtherANTHEM BLUE CROSS BLUE SHIELD
OH3137608Medicaid
KY7100149460Medicaid
611077369 1295716850OtherHEALTHNET
KY7100149460Medicaid
KYP00917264Medicare PIN
$$$$$$$$$00OtherBUREAU OF WORKERS COMP
KYP400041356Medicare PIN
OHP01017782Medicare PIN