Provider Demographics
NPI:1437671831
Name:PATRICK, CASSANDRA (CRNA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:WAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5031 FOREST DR STE C
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7088
Mailing Address - Country:US
Mailing Address - Phone:614-939-5416
Mailing Address - Fax:614-939-5417
Practice Address - Street 1:7333 SMITHS MILL RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9291
Practice Address - Country:US
Practice Address - Phone:614-939-5416
Practice Address - Fax:614-939-5417
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.019503367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty