Healthcare Provider Details

I. General information

NPI: 1790881621
Provider Name (Legal Business Name): PATRICIA M MCCORMICK DUPRE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA M DUPRE CRNA

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MEDICAL DRIVE SUITE B
LIMA OH
45804-4099
US

IV. Provider business mailing address

PO BOX 714813
COLUMBUS OH
43271
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-7586
  • Fax: 419-224-9769
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number037246
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN149531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: