Provider Demographics
NPI:1679571400
Name:OLIVETI, JOSEPH BRUNO (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRUNO
Last Name:OLIVETI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3455
Mailing Address - Country:US
Mailing Address - Phone:330-990-0718
Mailing Address - Fax:
Practice Address - Street 1:657 MARINA DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-3455
Practice Address - Country:US
Practice Address - Phone:330-990-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 145207367500000X
MI4704240687367500000X
PARN555078367500000X
CO162979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0751459Medicaid
OHOL8202841Medicare ID - Type Unspecified