Healthcare Provider Details

I. General information

NPI: 1720056906
Provider Name (Legal Business Name): JOHN VETORT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # STREET3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

3601 W. 13 MILE RD 400 FSC-PCS
ROYAL OAK MI
48073-6769
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-7280
  • Fax: 203-785-6664
Mailing address:
  • Phone: 248-423-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number76756
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: