Provider Demographics
NPI:1659591741
Name:WREN, PATRICIA ELZEY (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELZEY
Last Name:WREN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71147 KETCH PL
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3445
Mailing Address - Country:US
Mailing Address - Phone:985-276-8599
Mailing Address - Fax:
Practice Address - Street 1:360 EMERALD FOREST BLVD STE H
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5193
Practice Address - Country:US
Practice Address - Phone:985-892-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1563692Medicaid
LA1563692Medicaid
P39474Medicare UPIN