Healthcare Provider Details

I. General information

NPI: 1780101360
Provider Name (Legal Business Name): JEREMY ALFANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 8TH ST NE
MASSILLON OH
44646-8503
US

IV. Provider business mailing address

214 LAKE POINTE DR
AKRON OH
44333-1795
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-8761
  • Fax:
Mailing address:
  • Phone: 330-224-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118169
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: