Provider Demographics
NPI:1073625455
Name:JUERGENS, PATRICIA ANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:JUERGENS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AYRSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9379
Mailing Address - Country:US
Mailing Address - Phone:585-737-0578
Mailing Address - Fax:
Practice Address - Street 1:500 HAHNEMANN TRL
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2356
Practice Address - Country:US
Practice Address - Phone:585-383-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332779-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0140059HLOtherBCHOICE (OP) PHYS GRP
NY1158OtherBCROSS PHYSICANS GRP
NYG0180227590OtherBCHOICE PHYSCIAN GRP
NYP14960Medicare UPIN
NY81115AMedicare ID - Type UnspecifiedPART B PHYSICIAN GRP
NYG0180227590OtherBCHOICE PHYSCIAN GRP