Healthcare Provider Details

I. General information

NPI: 1881495471
Provider Name (Legal Business Name): JUSTIN MICHAEL ECKBERG DNP, RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

9155 EDISON ST NE
LOUISVILLE OH
44641-9736
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-4951
  • Fax:
Mailing address:
  • Phone: 330-904-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0021292
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number427345
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: