Provider Demographics
NPI:1386802650
Name:STOCKER, PATRICK (MSN CRNA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:STOCKER
Suffix:
Gender:M
Credentials:MSN CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-8692
Mailing Address - Country:US
Mailing Address - Phone:440-813-3225
Mailing Address - Fax:
Practice Address - Street 1:2420 LAKE ROAD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-0002
Practice Address - Country:US
Practice Address - Phone:440-997-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH311893163W00000X
OHRN311893367500000X
PARN593061367500000X
OHCOA10696NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131215VKCMedicare PIN