Individual
JOHN M. UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 480-3439
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
RN253175.1
OH
367500000X
Certified Registered Nurse Anesthetist
RN353261L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE PTAN
OH
05
—
PENDING
—
OH
Enumeration date
02/03/2016
Last updated
02/12/2016
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