Provider Demographics
NPI:1306096524
Name:RESTIFO, MARK ANTHONY
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:RESTIFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S STATE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3445
Mailing Address - Country:US
Mailing Address - Phone:440-357-6740
Mailing Address - Fax:440-357-0174
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3445
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:440-357-0174
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 206215163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health