Healthcare Provider Details

I. General information

NPI: 1588053367
Provider Name (Legal Business Name): JOSEPH WANSTRATH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DR
BLUE ASH OH
45242-5664
US

IV. Provider business mailing address

PO BOX 63252
CINCINNATI OH
45264-2572
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-3741
  • Fax: 513-569-3941
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.16983-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: