Provider Demographics
NPI:1639388754
Name:PASTERNAK, FRED BURT (RN)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:BURT
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 ALDERSGATE DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3859
Mailing Address - Country:US
Mailing Address - Phone:440-821-7630
Mailing Address - Fax:
Practice Address - Street 1:38680 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7831
Practice Address - Country:US
Practice Address - Phone:440-942-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN220356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse