Basic Information
| Provider Information | |||||||||
| NPI: | 1265494082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLATIKA | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 372 | ||||||||
| Address2: | |||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020720372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813413966 | ||||||||
| FaxNumber: | 7813418269 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 RICH VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | WAYLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017782428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083586236 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 10/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 138355 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN138355 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.