Provider Demographics
NPI:1609636083
Name:PATTERSON, JULIE ANN (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 DANCE MILL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-2119
Mailing Address - Country:US
Mailing Address - Phone:443-798-1704
Mailing Address - Fax:
Practice Address - Street 1:3727 DANCE MILL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-2119
Practice Address - Country:US
Practice Address - Phone:443-798-1704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023045205163WG0000X
TX1155402363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice