Provider Demographics
NPI:1457490328
Name:PATRICK, DONNA M (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:PATRICK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 755580
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99775-5580
Mailing Address - Country:US
Mailing Address - Phone:907-474-7043
Mailing Address - Fax:907-474-5777
Practice Address - Street 1:612 N. CHANDALAR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99775-5580
Practice Address - Country:US
Practice Address - Phone:907-474-7043
Practice Address - Fax:907-474-5777
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily