MEDICARE: PATRICIA ROACH NORCOM CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	053779	NC
2	367500000X	Certified Registered Nurse Anesthetist	26300	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245289750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ROACH NORCOM CRNA

Provider Business Mailing Address
First Line	:	PO BOX 601549
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1549
Country	:	US
Telephone Number	:	704-384-4239
Fax Number	:	704-384-5636

Provider Business Practice Location Address
First Line	:	2536 LENGERS WAY
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-7126
Country	:	US
Telephone Number	:	704-749-5800
Fax Number	:	704-626-3237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/30/2023

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