Basic Information
| Provider Information | |||||||||
| NPI: | 1245289750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORCOM | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601549 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043844239 | ||||||||
| FaxNumber: | 7043845636 | ||||||||
| Practice Location | |||||||||
| Address1: | 2536 LENGERS WAY | ||||||||
| Address2: | |||||||||
| City: | FORT MILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297077126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7046263237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 053779 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 26300 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8052065 | 05 | NC | MEDICAID | NAN413 | 05 | SC | MEDICAID |