Provider Demographics
NPI:1285639005
Name:MADER, PATRICIA C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:C
Last Name:MADER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14612 WOODSTREAM PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5164
Mailing Address - Country:US
Mailing Address - Phone:502-244-3330
Mailing Address - Fax:502-244-3330
Practice Address - Street 1:11209 VISTA GREENS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3444
Practice Address - Country:US
Practice Address - Phone:502-386-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4150P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000360626OtherANTHEM
KY50008080OtherPASSPORT
KY000000486305OtherANTHEM PIN
KY78011855Medicaid
KY2646419000OtherPASSPORT ADVANTAGE
KY50008080OtherPASSPORT
KY0962004Medicare ID - Type Unspecified
KY000000360626OtherANTHEM