Provider Demographics
NPI:1215977053
Name:STANTON, CHERYL ANNE (CRNA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:STANTON
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 1:9 ERNEST ST
Mailing Address - Street 2:
Mailing Address - City:DUNDAS
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L9H 5M4
Mailing Address - Country:CA
Mailing Address - Phone:905-481-2543
Mailing Address - Fax:
Practice Address - Street 1:2409 CHERRY ST #305
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:419-251-3740
Practice Address - Fax:419-251-3859
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694824Medicaid
OH8214401Medicare ID - Type Unspecified