=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235368044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES FRANCIS BOCCHICCHIO CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2009
-----------------------------------------------------
Last Update Date | 04/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4881 SUGAR MAPLE DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45433-5529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-986-9772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4881 SUGAR MAPLE DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45433-5529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-630-2168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN.CRNA.18162
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------