Provider Demographics
NPI:1093712150
Name:PATTERSON, BRUCE A (APRN)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4727
Mailing Address - Country:US
Mailing Address - Phone:860-443-7907
Mailing Address - Fax:860-442-6730
Practice Address - Street 1:276 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4727
Practice Address - Country:US
Practice Address - Phone:860-443-7907
Practice Address - Fax:860-442-6730
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000073363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004228955Medicaid
CT500000868Medicare PIN
CT500000103Medicare PIN
CTS83099Medicare UPIN