Provider Demographics
NPI:1134104755
Name:DUFFIELD, PATRICIA A (CNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:DUFFIELD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S BLOOMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2904
Mailing Address - Country:US
Mailing Address - Phone:815-673-2441
Mailing Address - Fax:815-672-2178
Practice Address - Street 1:301 S BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2904
Practice Address - Country:US
Practice Address - Phone:815-673-2441
Practice Address - Fax:815-672-2178
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68287Medicare UPIN
503830Medicare ID - Type UnspecifiedMINONK, IL
502270Medicare ID - Type UnspecifiedSTREATOR, IL