Individual
JONATHAN SCOTT GRIST
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
265331
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
RN356025-1
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730513342
—
NC
01
—
185VN
BCBS
NC
01
—
PENDING
MEDICARE PTAN
OH
05
—
PENDING
—
OH
Enumeration date
08/30/2013
Last updated
02/08/2016
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