Provider Demographics
NPI:1073829578
Name:PULVER, PATRICIA ANNE (PA)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:ANNE
Last Name:PULVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:NEW YORK STATE DEPARTMENT OF CORRECTIONS AND COMMUNITY
Mailing Address - Street 2:1220 WASHINGTON AVE, BUILDING 4
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12226-2050
Mailing Address - Country:US
Mailing Address - Phone:518-445-7565
Mailing Address - Fax:518-445-6157
Practice Address - Street 1:79 GLENRIDGE RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4523
Practice Address - Country:US
Practice Address - Phone:518-399-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002834-1363A00000X
NY002834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant