Provider Demographics
NPI:1710916358
Name:PATTERSON, AUDREY M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3374
Mailing Address - Country:US
Mailing Address - Phone:717-299-6371
Mailing Address - Fax:717-945-1587
Practice Address - Street 1:802 NEW HOLLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2288
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:717-945-1587
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50025728OtherCAPITAL BLUE CROSS
PA50025728OtherCAPITAL BLUE CROSS
P71932Medicare UPIN