Healthcare Provider Details

I. General information

NPI: 1639401581
Provider Name (Legal Business Name): JOSEPH ALEC KATRINCHAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E BROAD ST SUITE I
ELYRIA OH
44035-6542
US

IV. Provider business mailing address

127 CUMBERLAND CT
ELYRIA OH
44035-7389
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-8458
  • Fax:
Mailing address:
  • Phone: 440-365-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-244752
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: