Healthcare Provider Details

I. General information

NPI: 1609812429
Provider Name (Legal Business Name): PATRICK M MCCULLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 TIMBERLAKE METHODIST HOSPITAL
SACRAMENTO CA
95823
US

IV. Provider business mailing address

PO BOX 966 SUTTER CREEK OB ANESTHESIA SERVICES
SUTTER CREEK CA
95685
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-3000
  • Fax:
Mailing address:
  • Phone: 888-270-0340
  • Fax: 888-270-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN228688
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: