Provider Demographics
NPI:1629213129
Name:FIDDIE, PATRICIA IRENE
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:IRENE
Last Name:FIDDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E EASON AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-2602
Mailing Address - Country:US
Mailing Address - Phone:623-327-2284
Mailing Address - Fax:623-386-9705
Practice Address - Street 1:902 E EASON AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-2602
Practice Address - Country:US
Practice Address - Phone:623-327-2284
Practice Address - Fax:623-386-9705
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ576481390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program