Provider Demographics
NPI:1912720855
Name:MORROW, DOMINIC PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:PAUL
Last Name:MORROW
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 1:10137 ERIE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0206
Mailing Address - Country:US
Mailing Address - Phone:313-244-8630
Mailing Address - Fax:
Practice Address - Street 1:2243 BRIXTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3117
Practice Address - Country:US
Practice Address - Phone:614-940-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN276206367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered