Provider Demographics
NPI:1073583381
Name:PATT, EDWIN JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:PATT
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:PATIENT FINANCIAL SERVICES
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-777-0376
Mailing Address - Fax:414-777-0033
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:PATIENT FINANCIAL SERVICES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-777-0376
Practice Address - Fax:414-777-0033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47551030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0009Medicare ID - Type Unspecified