Provider Demographics
NPI:1629048038
Name:MERTES, PATRICIA A (RN, MS, FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MERTES
Suffix:
Gender:F
Credentials:RN, MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6260
Mailing Address - Street 2:230 MAPLE ST
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-6260
Mailing Address - Country:US
Mailing Address - Phone:413-420-2200
Mailing Address - Fax:413-420-2260
Practice Address - Street 1:203 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1246
Practice Address - Country:US
Practice Address - Phone:413-420-2222
Practice Address - Fax:413-592-2324
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2139OtherBLUE CROSS BLUE SHIELD
MAS95271Medicare UPIN
MANP2139OtherBLUE CROSS BLUE SHIELD