Basic Information
Provider Information
NPI: 1174589535
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRATEK
FirstName: PATRICIA
MiddleName: T
NamePrefix: MS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 HALL HIGHWAY
Address2:  
City: CRISFIELD
State: MD
PostalCode: 21817
CountryCode: US
TelephoneNumber: 4109681200
FaxNumber: 4109683005
Practice Location
Address1: 201 HALL HIGHWAY
Address2:  
City: CRISFIELD
State: MD
PostalCode: 21817
CountryCode: US
TelephoneNumber: 4109681200
FaxNumber: 4109683005
Other Information
ProviderEnumerationDate: 04/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XR132637MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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