Provider Demographics
NPI:1497032700
Name:DAHLSTROM, PATRICIA (MSN, CPNP, PHN, RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:MSN, CPNP, PHN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9551 BOTHWELL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2105
Mailing Address - Country:US
Mailing Address - Phone:818-624-4416
Mailing Address - Fax:
Practice Address - Street 1:9551 BOTHWELL RD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2105
Practice Address - Country:US
Practice Address - Phone:818-624-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514879163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management