Provider Demographics
NPI:1780706549
Name:BROOKOVER, PATRICIA P (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:BROOKOVER
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:PO BOX 20050
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0050
Mailing Address - Country:US
Mailing Address - Phone:740-387-6193
Mailing Address - Fax:740-387-6738
Practice Address - Street 1:899 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8371
Practice Address - Country:US
Practice Address - Phone:740-387-6193
Practice Address - Fax:740-387-6738
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN112576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0793182Medicaid
OHBR8223846Medicare ID - Type Unspecified