Healthcare Provider Details

I. General information

NPI: 1982650529
Provider Name (Legal Business Name): ALBERT J PITOSCIA JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 E 3RD ST SUITE 20
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-4626
  • Fax:
Mailing address:
  • Phone: 763-559-3779
  • Fax: 763-450-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR106610-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: