Provider Demographics
NPI:1548233273
Name:KETTINGER, DONALD JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:KETTINGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 RUTLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5204
Mailing Address - Country:US
Mailing Address - Phone:419-872-9442
Mailing Address - Fax:
Practice Address - Street 1:1307 FEDERAL STREET SUITE 101
Practice Address - Street 2:STEEL CITY ANESTHESIA, LLC
Practice Address - City:PITTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:330-286-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA02056NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0799177Medicaid
OH8208566Medicare PIN
OH0799177Medicaid