Individual
MR. JOHN C MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2793 SHAWNEE RD, LIMA, OH 45806
(419) 879-3636
(419) 879-4312
Mailing address
2793 SHAWNEE RD, LIMA, OH 45806-1444
(419) 879-3636
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
079739
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578745568
—
OH
05
—
2890395
—
OH
01
—
P00682422
RAILROAD MEDICARE
OH
Enumeration date
08/12/2008
Last updated
10/03/2019
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