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NPI Code Detail

MEDICARE: KASSANDRA PETSOCK MSN, CRNA

MEDICARE: KASSANDRA PETSOCK MSN, 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
1367500000XCertified Registered Nurse Anesthetist137429OH

General Provider Information

NPI Number : 1487305702
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSANDRA PETSOCK MSN, CRNA
Provider Business Mailing Address
First Line : 345 AVON BELDEN RD
Second Line :
City : AVON LAKE
State : OH
Zip : 44012-2203
Country : US
Telephone Number : 740-350-6229
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0002
Country : US
Telephone Number : 216-444-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2022
Last Update Date : 03/04/2026

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