Provider Demographics
NPI:1346211737
Name:MCVICKER, JOSEPH PATRICK (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:MCVICKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 YACHT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9085
Mailing Address - Country:US
Mailing Address - Phone:252-393-1109
Mailing Address - Fax:252-393-1109
Practice Address - Street 1:NAVAL HOSPITAL, ANESTHESIA DEPARTMENT
Practice Address - Street 2:100 BREWSTER BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-450-3326
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168656163W00000X, 367500000X
ARC01382367500000X
VA0024165747367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44313600Medicaid
WI44313600Medicaid