Individual
PATRICIA M MCCORMICK DUPRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 MEDICAL DRIVE, SUITE B, LIMA, OH 45804-4099
(419) 224-7586
(419) 224-9769
Mailing address
PO BOX 714813, COLUMBUS, OH 43271
(937) 293-0247
(937) 293-0960
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
037246
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
RN149531
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226089
UNISON
OH
01
—
000000515999
ANTHEM
OH
01
—
037246
CRNA LICENSE
OH
01
—
0583328
BCMH
OH
05
—
2135684
—
OH
01
—
414347
WELLCARE MEDICAID
OH
01
—
7441733
AETNA
—
01
—
746241
BUCKEYE MEDICAID
OH
Enumeration date
09/16/2006
Last updated
05/19/2008
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