Provider Demographics
NPI:1417453549
Name:MUIR, PATRICIA MARIE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:MUIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-3827
Mailing Address - Country:US
Mailing Address - Phone:631-957-6169
Mailing Address - Fax:
Practice Address - Street 1:30 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3827
Practice Address - Country:US
Practice Address - Phone:631-957-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430555-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse