MEDICARE: JONATHAN PACHECO DNP, CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	505512	OH
2	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.0021299	OH

General Provider Information

NPI Number	:	1285463463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN PACHECO DNP, CRNA

Provider Business Mailing Address
First Line	:	3725 SUTHERLAND RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5136
Country	:	US
Telephone Number	:	719-242-5216
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 SUTHERLAND RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5136
Country	:	US
Telephone Number	:	719-242-5216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	05/22/2025

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