Individual
MARIE GRACE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5319 HOAG DRIVE, ELYRIA, OH 44035-1494
(440) 930-6042
Mailing address
13523 BARRETT PARKWAY DRIVE, SUITE 104, BALLWIN, MO 63021-3802
(636) 938-1486
(636) 938-1486
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA11303-NA
OH
367500000X
Certified Registered Nurse Anesthetist
RN-311442
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3022071
—
OH
01
—
P00880290
RAILROAD MEDICARE
OH
Enumeration date
12/16/2009
Last updated
10/24/2016
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