Healthcare Provider Details

I. General information

NPI: 1942454194
Provider Name (Legal Business Name): MR. DUANE JOHN PANNUNZIO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DUANE JOHN PANNUNZIO SR. RN

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 09/20/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 PORTER AVE N/A
CAMPBELL OH
44405-1456
US

IV. Provider business mailing address

369 PORTER AVE
CAMPBELL OH
44405-1456
US

V. Phone/Fax

Practice location:
  • Phone: 330-519-1824
  • Fax:
Mailing address:
  • Phone: 330-519-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN214395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: