Healthcare Provider Details

I. General information

NPI: 1396417838
Provider Name (Legal Business Name): JOHN ANTHONY CAMUSO II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

IV. Provider business mailing address

1265 CHEROKEE DR
YOUNGSTOWN OH
44511-1379
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-1106
  • Fax: 330-747-0491
Mailing address:
  • Phone: 330-774-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0030039
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0030039
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0030039
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.383930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: