Provider Demographics
NPI:1235651092
Name:PIENAAR, PATRICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PIENAAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-5602
Mailing Address - Country:US
Mailing Address - Phone:937-716-5322
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD STE 3750
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1268
Practice Address - Country:US
Practice Address - Phone:937-610-3220
Practice Address - Fax:937-610-3225
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant