Basic Information
Provider Information
NPI: 1487939294
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWEENE
FirstName: CAROLYN
MiddleName: A
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 860 EAST BROAD STREET
Address2: SUITE I
City: ELYRIA
State: OH
PostalCode: 440356542
CountryCode: US
TelephoneNumber: 4403238458
FaxNumber: 4403237900
Practice Location
Address1: 630 EAST RIVER STREET
Address2:  
City: ELYRIA
State: OH
PostalCode: 44035
CountryCode: US
TelephoneNumber: 4403297500
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2011
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN.320808OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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