Provider Demographics
NPI:1386695179
Name:KOLECK, DONNA LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:KOLECK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:740 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3328
Practice Address - Country:US
Practice Address - Phone:724-983-7310
Practice Address - Fax:724-983-2797
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN314025-COA1367500000X
PARN268802L367500000X
OHNA-07944367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH253597Medicaid
OH000000610126OtherANTHEM BCBS
PA011438ZB29OtherMEDICARE PTAN
PAP00793461OtherMEDICARE RAILROAD