Healthcare Provider Details

I. General information

NPI: 1811972516
Provider Name (Legal Business Name): PATRICIA LARSEN MCKENNA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 EVERSON ST
SAN FRANCISCO CA
94131-2637
US

IV. Provider business mailing address

126 EVERSON ST
SAN FRANCISCO CA
94131-2637
US

V. Phone/Fax

Practice location:
  • Phone: 408-896-6000
  • Fax:
Mailing address:
  • Phone: 408-896-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024083218
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC000279
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN59684
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: