Provider Demographics
NPI:1265494082
Name:PLATIKA, PATRICIA C (CRNA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:C
Last Name:PLATIKA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 372
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0372
Mailing Address - Country:US
Mailing Address - Phone:781-341-3966
Mailing Address - Fax:781-341-8269
Practice Address - Street 1:50 RICH VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2428
Practice Address - Country:US
Practice Address - Phone:508-358-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138355367500000X
MARN138355367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA1193Medicare PIN