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Individual

MS. MARY F SROGA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
77 E WOODBURY DR, SUITE 110, DAYTON, OH 45415-2855
(937) 277-1722
(937) 277-8618
Mailing address
2912 SPRINGBORO RD, SUITE 201, MORAINE, OH 45439-1674
(937) 297-8999
(937) 297-4852

Taxonomy

Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
COA.03552-NP
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000558163
BCBS-OH
OH
05
2059203
OH
01
421534506111
CARESOURCE
OH
01
421534506117
CARESOURCE
OH
Enumeration date
06/27/2006
Last updated
07/16/2014
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