MEDICARE: PATRICIA A LAROSS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	0004	NV

General Provider Information

NPI Number	:	1578639258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A LAROSS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 60596
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89160-0596
Country	:	US
Telephone Number	:	702-795-8808
Fax Number	:	702-795-8809

Provider Business Practice Location Address
First Line	:	1785 E SAHARA AVE
Second Line	:	STE 320
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3733
Country	:	US
Telephone Number	:	702-795-8808
Fax Number	:	702-795-8809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	02/13/2008

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