Provider Demographics
NPI:1114933165
Name:MUTTERER, PATRICIA IRENE (NPP (NURSE PRACTI)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:IRENE
Last Name:MUTTERER
Suffix:
Gender:F
Credentials:NPP (NURSE PRACTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4 ATRIUM DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1441
Mailing Address - Country:US
Mailing Address - Phone:518-374-0295
Mailing Address - Fax:518-377-3729
Practice Address - Street 1:260 SOUTH PEARL STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1809
Practice Address - Country:US
Practice Address - Phone:518-447-4555
Practice Address - Fax:518-447-4661
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY288683-1163WP0808X
NYF400332-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health