Healthcare Provider Details

I. General information

NPI: 1245289750
Provider Name (Legal Business Name): PATRICIA ROACH NORCOM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 LENGERS WAY
FORT MILL SC
29707-7126
US

IV. Provider business mailing address

PO BOX 601549
CHARLOTTE NC
28260-1549
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-5800
  • Fax: 704-626-3237
Mailing address:
  • Phone: 704-384-4239
  • Fax: 704-384-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number053779
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26300
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: