Provider Demographics
NPI:1578974150
Name:MCDERMOTT, PATRICIA DENISE (LVN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DENISE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:DENISE
Other - Last Name:GREEN, COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-6600
Mailing Address - Fax:661-868-6666
Practice Address - Street 1:17695 INDRUSTRIAL FARM ROAD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:661-397-7948
Practice Address - Fax:661-391-7978
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276931164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse