Healthcare Provider Details

I. General information

NPI: 1487770962
Provider Name (Legal Business Name): LORRAINE T CRESANTO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 E STATE ST STE B
SALEM OH
44460-4409
US

IV. Provider business mailing address

2094 E STATE ST STE B
SALEM OH
44460-4409
US

V. Phone/Fax

Practice location:
  • Phone: 330-337-8709
  • Fax: 330-337-9019
Mailing address:
  • Phone: 330-337-8709
  • Fax: 330-337-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP08527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: