Healthcare Provider Details

I. General information

NPI: 1295788610
Provider Name (Legal Business Name): MICHAEL J NOSKY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AUSTIN AVE NW
MASSILLON OH
44646-3554
US

IV. Provider business mailing address

PO BOX 74994
CLEVELAND OH
44194-1077
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-7200
  • Fax: 330-837-7572
Mailing address:
  • Phone: 614-430-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN295739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: