1285698456 NPI number — MRS. PATRICIA MCNAMARA WADFORD CRNA

Table of content: MRS. PATRICIA MCNAMARA WADFORD CRNA (NPI 1285698456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285698456 NPI number — MRS. PATRICIA MCNAMARA WADFORD CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WADFORD
Provider First Name:
PATRICIA
Provider Middle Name:
MCNAMARA
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285698456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 CANTERBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENT WOODS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-633-3362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 ARENDELL ST
Provider Second Line Business Practice Location Address:
PO DRAWER 1619
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-808-6818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2006

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:  045161 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8051761 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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