Individual
THERESA LYNNE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
200 E STATE ST, ALLIANCE, OH 44601-4936
(330) 286-5330
(330) 286-5396
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.02076
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0932361
—
OH
01
—
P02145866
MEDICARE RAILROAD PTAN
OH
Enumeration date
07/14/2006
Last updated
01/29/2020
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