Healthcare Provider Details

I. General information

NPI: 1013345941
Provider Name (Legal Business Name): JOSEPH MARINARO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 04/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2420 SWEETBRIAR LN
WESTCHESTER IL
60154-5941
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-8785
  • Fax:
Mailing address:
  • Phone: 954-646-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.011281
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: