Healthcare Provider Details

I. General information

NPI: 1386913341
Provider Name (Legal Business Name): MARY ELIZABETH PATTERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD SUITE 105
CHESTER PA
19013-3955
US

IV. Provider business mailing address

646 LEVERINGTON AVE
PHILADELPHIA PA
19128-2606
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-6448
  • Fax:
Mailing address:
  • Phone: 610-608-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN565804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: