Provider Demographics
NPI:1518947738
Name:PRATT, PATTI LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:LEE
Last Name:PRATT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:LEE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:357 FRUITWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1057
Mailing Address - Country:US
Mailing Address - Phone:412-266-1465
Mailing Address - Fax:
Practice Address - Street 1:357 FRUITWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1057
Practice Address - Country:US
Practice Address - Phone:412-266-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN217232L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA855946RUAMedicare ID - Type Unspecified