Individual
JOHNNY J SACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 421-6283
Mailing address
1925 WARRIOR WAY, ADA, OK 74820-3491
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1079255
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
94306
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009974030
—
AL
05
—
200227680A
—
OK
Enumeration date
02/13/2006
Last updated
07/10/2024
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