Individual
COLLEEN T MASTERNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8135 MARKET ST, YOUNGSTOWN, OH 44512-6244
(330) 758-0900
(330) 758-2790
Mailing address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN-165483
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000644312
ANTHEM BCBS
OH
05
—
0770205
—
OH
01
—
11932484
CAQH
—
01
—
8246361
MEDICARE PTAN
OH
Enumeration date
03/01/2006
Last updated
04/10/2019
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