Individual
NICOLE MARIE PUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 480-3439
Mailing address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN334168-COA1
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096690
—
OH
01
—
H254610
MEDICARE PTAN
OH
Enumeration date
01/15/2014
Last updated
04/07/2014
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