MEDICARE: MR. JOSEPH BRUNO OLIVETI 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	367500000X	Certified Registered Nurse Anesthetist	RN 145207	OH
2	367500000X	Certified Registered Nurse Anesthetist	4704240687	MI
3	367500000X	Certified Registered Nurse Anesthetist	RN555078	PA
4	367500000X	Certified Registered Nurse Anesthetist	162979	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679571400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH BRUNO OLIVETI CRNA

Provider Business Mailing Address
First Line	:	657 MARINA DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-3455
Country	:	US
Telephone Number	:	330-990-0718
Fax Number	:

Provider Business Practice Location Address
First Line	:	657 MARINA DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-3455
Country	:	US
Telephone Number	:	330-990-0718
Fax Number	:

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/26/2012

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