1467689703 NPI number — PATTIE WARREN WASHINGTON CRNA

Table of content: PATTIE WARREN WASHINGTON CRNA (NPI 1467689703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467689703 NPI number — PATTIE WARREN WASHINGTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
PATTIE
Provider Middle Name:
WARREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARREN
Provider Other First Name:
PATTIE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467689703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 W MCDERMOTT DR # 116-371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-6510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-541-1600
Provider Business Mailing Address Fax Number:
469-541-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 MEDICAL CENTER DR STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75069-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-541-1600
Provider Business Practice Location Address Fax Number:
469-541-1612
Provider Enumeration Date:
06/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  651860 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: AP116560 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8553UJ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 211913304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01446847 . This is a "RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".