Healthcare Provider Details

I. General information

NPI: 1982127940
Provider Name (Legal Business Name): JOSEPH ANTHONY CONSTANTINO MSN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 10/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E RIVER ST
ELYRIA OH
44035-5902
US

IV. Provider business mailing address

880 ORCHARD PARK DR
ROCKY RIVER OH
44116-2039
US

V. Phone/Fax

Practice location:
  • Phone: 216-548-3924
  • Fax:
Mailing address:
  • Phone: 216-548-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number019567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: