Provider Demographics
NPI:1669587911
Name:AGRA, ARLENE G (CRNA)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:G
Last Name:AGRA
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 1:36151 GRAFTON EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9637
Mailing Address - Country:US
Mailing Address - Phone:216-870-8471
Mailing Address - Fax:
Practice Address - Street 1:860 EAST BROAD STREET
Practice Address - Street 2:SUITE I
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-323-8458
Practice Address - Fax:440-323-7900
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203557367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625949Medicaid
OH8236121Medicare ID - Type Unspecified