Provider Demographics
NPI:1033176821
Name:MCGRAW, KAREN SUE (CRNA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:MCGRAW
Other - Last Name:MATTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2315 MERRIMONT DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4429
Mailing Address - Country:US
Mailing Address - Phone:937-335-3595
Mailing Address - Fax:614-459-7824
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:614-459-7830
Practice Address - Fax:614-459-7824
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN206385367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000286050OtherANTHEM PROVIDER #
OH0166065Medicaid
OH0166065Medicaid