Provider Demographics
NPI:1962642751
Name:FONTANA, JOHN J (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:FONTANA
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:PO BOX 8654
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-0654
Mailing Address - Country:US
Mailing Address - Phone:509-362-9653
Mailing Address - Fax:509-362-9705
Practice Address - Street 1:507 S WASHINGTON ST STE 170
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2629
Practice Address - Country:US
Practice Address - Phone:509-362-9653
Practice Address - Fax:509-362-9705
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA81488367500000X
WAAP60068032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered