Provider Demographics
NPI:1780726950
Name:PRATER, JOE RICHARD (CRNA)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:RICHARD
Last Name:PRATER
Suffix:
Gender:M
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 1807
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43301-1807
Mailing Address - Country:US
Mailing Address - Phone:740-383-7000
Mailing Address - Fax:
Practice Address - Street 1:651 WEST MARION ROAD
Practice Address - Street 2:
Practice Address - City:MT. GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338
Practice Address - Country:US
Practice Address - Phone:419-949-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN238732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145477Medicaid
OH8221621Medicare PIN