MEDICARE: KLAIRE MARIE PATTERSON 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	NA 1572	CA

General Provider Information

NPI Number	:	1942368790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KLAIRE MARIE PATTERSON CRNA

Provider Business Mailing Address
First Line	:	24034 BRIARDALE WAY
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-3946
Country	:	US
Telephone Number	:	661-755-2797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 LYNN RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1980
Country	:	US
Telephone Number	:	661-755-2797
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/02/2017

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