Healthcare Provider Details

I. General information

NPI: 1700214111
Provider Name (Legal Business Name): JENNA SAMMARTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA HAMROCK

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 SOUTHERN BLVD
BOARDMAN OH
44512
US

IV. Provider business mailing address

7630 SOUTHERN BLVD
BOARDMAN OH
44512-5633
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-1954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.342058 COA.15168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: