Individual
MR. JOHN MARC PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 702-6700
Mailing address
1042 RIVEROAKS CT, RANDLEMAN, NC 27317-7987
(630) 607-9949
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
209001255
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
6183
NC
Other
Enumeration date
01/24/2006
Last updated
02/17/2023
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