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General NPI Number Information
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NPI Number | 1457389868
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Entity Type | Individual
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Provider Name | JOHN SAMUEL POLECHETTI CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 2200 S HOUGHTON RD
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City | TUCSON
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State | AZ
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Zip | 85748-7632
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Country | US
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Telephone | 520-742-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 555 PINE ST
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City | LOCKPORT
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State | NY
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Zip | 14094-5547
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Country | US
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Telephone | 716-465-0222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3315571
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License Number State | NY
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