Individual
JEFFREY BISESI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6847 N CHESTNUT ST, RAVENNA, OH 44266-3929
(330) 297-0811
Mailing address
990 COTSWOLD DR, COPLEY, OH 44321-1620
(330) 297-0811
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN055053
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000243499
ANTHEM PROVIDER NUMBER
OH
05
—
2351511
—
OH
Enumeration date
01/02/2007
Last updated
07/08/2007
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