Provider Demographics
NPI:1225156995
Name:BAK, PATRICIA S (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:S
Last Name:BAK
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:508-764-2432
Practice Address - Street 1:128 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1556
Practice Address - Country:US
Practice Address - Phone:508-347-7585
Practice Address - Fax:508-347-7538
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR38709163WD0400X
MARN145129163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator