Provider Demographics
NPI:1487770962
Name:CRESANTO, LORRAINE T (CRNP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:T
Last Name:CRESANTO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 E STATE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-4409
Mailing Address - Country:US
Mailing Address - Phone:330-337-8709
Mailing Address - Fax:330-337-9019
Practice Address - Street 1:2094 E STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-4409
Practice Address - Country:US
Practice Address - Phone:330-337-8709
Practice Address - Fax:330-337-9019
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2790994Medicaid
OHNP08527OtherSTATE LICENSE
OH2790994Medicaid