Provider Demographics
NPI:1619097391
Name:MCNULTY, PATRICIA COLLEEN (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:COLLEEN
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:8019 COUNTRY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4691
Mailing Address - Country:US
Mailing Address - Phone:907-444-7275
Mailing Address - Fax:
Practice Address - Street 1:4130 SAN ERNESTO AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2875
Practice Address - Country:US
Practice Address - Phone:907-729-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12060163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKQ43252Medicare UPIN
AK8EB581Medicare PIN
AK8EB582Medicare PIN
AK8EB584Medicare PIN
AK8EB583Medicare PIN
AK8EB580Medicare PIN