Provider Demographics
NPI:1235211368
Name:PATTERSON, MARCIA L (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 BIG HORN CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9094
Mailing Address - Country:US
Mailing Address - Phone:831-264-5325
Mailing Address - Fax:
Practice Address - Street 1:2698 BIG HORN CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9094
Practice Address - Country:US
Practice Address - Phone:831-264-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0201819363LA2200X
COAPN.0100024-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29533082Medicaid
S67556Medicare UPIN
CO29533082Medicaid