Provider Demographics
NPI:1801353479
Name:DIMARINO, JENNIFER (CRNA)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DIMARINO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MESAROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 932759
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0015
Mailing Address - Country:US
Mailing Address - Phone:866-282-7905
Mailing Address - Fax:800-731-0751
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-293-8228
Practice Address - Fax:937-293-8229
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020142367500000X
OHRN.388449367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered