Provider Demographics
NPI:1609935865
Name:MCTIER, PATRICIA DALE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DALE
Last Name:MCTIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 DOC MCTIER RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-5943
Mailing Address - Country:US
Mailing Address - Phone:912-366-8644
Mailing Address - Fax:912-366-8645
Practice Address - Street 1:1781 DOC MCTIER RD
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-5943
Practice Address - Country:US
Practice Address - Phone:912-366-8644
Practice Address - Fax:912-366-8645
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089623163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty