Healthcare Provider Details

I. General information

NPI: 1871546416
Provider Name (Legal Business Name): JOHN M LESKOVAC CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

4665 DOUGLAS CIR NW STE 100
CANTON OH
44718-3673
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-3679
  • Fax: 330-884-3691
Mailing address:
  • Phone: 330-759-9350
  • Fax: 330-759-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN281961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: