Provider Demographics
NPI:1609985977
Name:MCINTOSH, PATRICIA ELAINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELAINE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 E TRAVERSE HWY
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6219
Mailing Address - Country:US
Mailing Address - Phone:261-947-1112
Mailing Address - Fax:231-947-7739
Practice Address - Street 1:10767 E TRAVERSE HWY
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6219
Practice Address - Country:US
Practice Address - Phone:261-947-1112
Practice Address - Fax:231-947-7739
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704076658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3462994Medicaid
MI500866378OtherBCBS
MI500866378OtherBCBS
MI3462994Medicaid