Provider Demographics
NPI:1043294135
Name:DIFFENDALE, PATRICIA A (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:DIFFENDALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9621
Mailing Address - Country:US
Mailing Address - Phone:413-283-5545
Mailing Address - Fax:
Practice Address - Street 1:175 STATE AVE
Practice Address - Street 2:MONSON DEVELOPMENTAL CTR
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1843
Practice Address - Country:US
Practice Address - Phone:413-283-3411
Practice Address - Fax:413-283-1361
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119025363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2354OtherBLUE CROSS BLUE SHIELD
MA0706311Medicaid
MANP2354OtherBLUE CROSS BLUE SHIELD
MAP04329Medicare UPIN