Provider Demographics
NPI:1689609752
Name:OKONIEWSKI, PATRICIA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:OKONIEWSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:78 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-3317
Mailing Address - Country:US
Mailing Address - Phone:315-592-2752
Mailing Address - Fax:
Practice Address - Street 1:453 PARK STREET
Practice Address - Street 2:MICHAUD RESIDENTIAL HEALTH SERVICE
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-3317
Practice Address - Country:US
Practice Address - Phone:315-592-2009
Practice Address - Fax:315-592-2942
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3307791363LF0000X
FL9220216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P17032Medicare UPIN
CC3025Medicare ID - Type Unspecified