Provider Demographics
NPI:1457310310
Name:NURSE, PATRICIA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:NURSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 MAIN ST
Mailing Address - Street 2:PO BOX 746
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920
Mailing Address - Country:US
Mailing Address - Phone:207-672-4187
Mailing Address - Fax:207-672-3641
Practice Address - Street 1:237 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAM
Practice Address - State:ME
Practice Address - Zip Code:04920
Practice Address - Country:US
Practice Address - Phone:207-672-4187
Practice Address - Fax:207-672-3641
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER016052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES98617Medicare UPIN
ME500025218Medicare PIN
MENP2196Medicare PIN