Provider Demographics
NPI:1215909510
Name:CRAKER, JOHN M (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CRAKER
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 1:12941 STONECREEK DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8424
Mailing Address - Country:US
Mailing Address - Phone:614-552-0061
Mailing Address - Fax:614-552-0168
Practice Address - Street 1:600 N PICKAWAY ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2409
Practice Address - Country:US
Practice Address - Phone:614-552-0061
Practice Address - Fax:614-552-0168
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA-048980367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221301OtherUNISON
OH0583328OtherBCMH
OH000000521137OtherANTHEM
OH734659OtherBUCKEYE MEDICAID
OH7800759OtherAETNA
OHP00908723OtherMEDICARE RAILROAD
OH2219094Medicaid
OH414957OtherWELLCARE MEDICAID
OHP00908723OtherMEDICARE RAILROAD
OH7800759OtherAETNA