Provider Demographics
NPI:1629671532
Name:GASCOYNE, PATRICIA
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:GASCOYNE
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 1:17973 RAVENNA RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-9101
Mailing Address - Country:US
Mailing Address - Phone:330-310-5311
Mailing Address - Fax:
Practice Address - Street 1:17973 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-9101
Practice Address - Country:US
Practice Address - Phone:330-310-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386575Medicaid