Provider Demographics
NPI:1386637601
Name:STOERKEL, LUCILLE M (CRNA)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:M
Last Name:STOERKEL
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 1:19250 BAGLEY RD
Mailing Address - Street 2:#101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3314
Mailing Address - Country:US
Mailing Address - Phone:440-891-8800
Mailing Address - Fax:440-891-1734
Practice Address - Street 1:19250 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3314
Practice Address - Country:US
Practice Address - Phone:440-826-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN113670367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098653Medicaid
OH000000327111OtherANTHEM BCBS
OH2098653Medicaid