Provider Demographics
NPI:1427233774
Name:KETELES, SHEILA LOU (CRNA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:LOU
Last Name:KETELES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:LOU
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8823
Mailing Address - Fax:330-543-3593
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8823
Practice Address - Fax:330-543-3593
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.09864367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1770547408OtherNPI ORGANIZATION
OH7091249OtherMEDICAID GROUP
OH340891295067OtherMMO CRNA GROUP
OH8000281OtherMEDICARE CRNA GROUP
OH2080224OtherUHC PROVIDER GROUP