Provider Demographics
NPI:1225028350
Name:NORDMAN, PATRICIA J (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:NORDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1601 PARKVIEW AVE
Mailing Address - Street 2:CREDENTIALING S200
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1822
Mailing Address - Country:US
Mailing Address - Phone:815-734-6061
Mailing Address - Fax:815-734-9021
Practice Address - Street 1:405 CHARLES ST
Practice Address - Street 2:UNIVERSITY PRIMARY CARE CLINIC @ MT MORRIS
Practice Address - City:MOUNT MORRIS
Practice Address - State:IL
Practice Address - Zip Code:61054-1646
Practice Address - Country:US
Practice Address - Phone:815-734-6061
Practice Address - Fax:815-734-9021
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209001503OtherIL STATE LICENSE
ILS29543Medicare UPIN
IL567350Medicare PIN