Provider Demographics
NPI:1245734698
Name:PATTERSON, ALISA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ANN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:MIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:465 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1014
Mailing Address - Country:US
Mailing Address - Phone:518-736-3890
Mailing Address - Fax:
Practice Address - Street 1:465 N PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095
Practice Address - Country:US
Practice Address - Phone:518-736-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548401163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management