Healthcare Provider Details

I. General information

NPI: 1437143567
Provider Name (Legal Business Name): PATRICIA HELEN FAIRTILE C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GLESSNER AVE
MANSFIELD OH
44903-2269
US

IV. Provider business mailing address

930 27TH ST NE
MASSILLON OH
44646-2983
US

V. Phone/Fax

Practice location:
  • Phone: 419-526-8355
  • Fax:
Mailing address:
  • Phone: 330-830-8833
  • Fax: 330-830-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN140343 NA00548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: