Provider Demographics
NPI:1497717268
Name:TREVERTON, PATRICIA L (ANP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:TREVERTON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1118
Mailing Address - Country:US
Mailing Address - Phone:716-285-8248
Mailing Address - Fax:
Practice Address - Street 1:1302 MAIN ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1118
Practice Address - Country:US
Practice Address - Phone:716-285-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300619363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2184009Medicaid
NYP89055Medicare UPIN
NYDD5590Medicare ID - Type Unspecified