Provider Demographics
NPI:1225660632
Name:PATSON, AMBER LEE MADRID (CRNA, DNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE MADRID
Last Name:PATSON
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LEE
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2909
Mailing Address - Country:US
Mailing Address - Phone:907-350-3358
Mailing Address - Fax:
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1496
Practice Address - Country:US
Practice Address - Phone:718-470-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK31519163WC0200X
NY787337367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine