Provider Demographics
NPI:1437143567
Name:FAIRTILE, PATRICIA HELEN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:HELEN
Last Name:FAIRTILE
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 1:930 27TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2983
Mailing Address - Country:US
Mailing Address - Phone:330-830-8833
Mailing Address - Fax:330-830-8833
Practice Address - Street 1:335 GLESSNER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2269
Practice Address - Country:US
Practice Address - Phone:419-526-8355
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN140343 NA00548367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH641005Medicaid
OH641005Medicaid