Provider Demographics
NPI:1124078928
Name:PATRICK, STEPHANIE FAYE (RN, CRNA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:FAYE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:FAYE
Other - Last Name:SAWYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CRNA
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:OUTPATIENT ANESTHESIA SPECIALISTS
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-0807
Mailing Address - Country:US
Mailing Address - Phone:513-204-5696
Mailing Address - Fax:877-284-4283
Practice Address - Street 1:4549 RAYNOR COURT
Practice Address - Street 2:OUTPATIENT ANESTHESIA SPECIALISTS
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-204-5696
Practice Address - Fax:877-284-4283
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-286110163W00000X
OHNA-08698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2963280Medicaid
KY000000532763OtherANTHEM BCBS
KY7100014120Medicaid
KY000000532763OtherANTHEM BCBS
OHPA8243601Medicare PIN