Provider Demographics
NPI:1376814996
Name:RANCOUR, PATRICE ELLEN (MS, RN, PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:ELLEN
Last Name:RANCOUR
Suffix:
Gender:F
Credentials:MS, RN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KENNY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3555
Mailing Address - Country:US
Mailing Address - Phone:614-293-7777
Mailing Address - Fax:614-293-9776
Practice Address - Street 1:2000 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3555
Practice Address - Country:US
Practice Address - Phone:614-293-7777
Practice Address - Fax:614-293-9776
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-125605163WP0809X
OHCOA01381 NS364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081646Medicaid
OHH180771Medicare PIN