Provider Demographics
NPI:1992988745
Name:LEWELLYN, KATY STALLO (CRNA)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:STALLO
Last Name:LEWELLYN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:SUZANNE
Other - Last Name:STALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MEDICAL STAFF SERVICES, ML 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-0356
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ANESTHESIA, ML 2001
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4408
Practice Address - Fax:513-636-7337
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09884367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered