Healthcare Provider Details

I. General information

NPI: 1831393370
Provider Name (Legal Business Name): PATRICIA A. BRISSETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA A GWAYI-CHORE CRNA

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE # A5W-588
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0942
  • Fax: 410-550-0443
Mailing address:
  • Phone: 717-812-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR143688
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN561180
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: