Provider Demographics
NPI:1144556697
Name:CHRISTNER, STACI ANN (CRNA)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:ANN
Last Name:CHRISTNER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:ANN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:844 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2008
Mailing Address - Country:US
Mailing Address - Phone:234-801-8100
Mailing Address - Fax:330-365-9970
Practice Address - Street 1:659 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2026
Practice Address - Country:US
Practice Address - Phone:330-602-0767
Practice Address - Fax:330-365-3831
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN279446367500000X
FLAPRN11018551367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016917Medicaid
OHH181190OtherMCR