Provider Demographics
NPI:1093101073
Name:WOZNIAK, PATRICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3528 ROUND ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-6239
Mailing Address - Country:US
Mailing Address - Phone:765-491-6269
Mailing Address - Fax:
Practice Address - Street 1:3528 ROUND ROCK CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-6239
Practice Address - Country:US
Practice Address - Phone:765-491-6269
Practice Address - Fax:765-435-7295
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1111760363A00000X
CA61475363A00000X
IN10001803A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant