Provider Demographics
NPI:1518109586
Name:CROSSEN, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CROSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:
Other - Last Name:CROSSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:920 CHURCH ST N
Mailing Address - Street 2:NORTHEAST TRANSITION OF CARE
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2927
Mailing Address - Country:US
Mailing Address - Phone:704-403-3970
Mailing Address - Fax:704-403-3960
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:NORTHEAST TRANSITION OF CARE
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-3970
Practice Address - Fax:704-403-3960
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164446363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2594190AOtherMEDICARE, INDIVIDUAL
NC232009OtherMEDICARE, GROUP