Healthcare Provider Details

I. General information

NPI: 1265494082
Provider Name (Legal Business Name): PATRICIA C. PLATIKA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 RICH VALLEY RD
WAYLAND MA
01778-2428
US

IV. Provider business mailing address

P.O. BOX 372
STOUGHTON MA
02072-0372
US

V. Phone/Fax

Practice location:
  • Phone: 508-358-6236
  • Fax:
Mailing address:
  • Phone: 781-341-3966
  • Fax: 781-341-8269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number138355
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN138355
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: