Provider Demographics
NPI:1194056093
Name:SLAZINIK, CAROL ANN (CRNA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:SLAZINIK
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 1:8634 BLACKJACK HOLLOWS LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2550
Mailing Address - Country:US
Mailing Address - Phone:618-789-0766
Mailing Address - Fax:
Practice Address - Street 1:8634 BLACKJACK HOLLOW LN
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294
Practice Address - Country:US
Practice Address - Phone:186-789-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005023282367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194056093OtherNPI