Provider Demographics
NPI:1760782700
Name:MCDONOUGH, PATTY ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:ANN
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-0992
Mailing Address - Country:US
Mailing Address - Phone:707-845-9099
Mailing Address - Fax:707-677-3575
Practice Address - Street 1:51 MIDWAY DRIVE
Practice Address - Street 2:SPACE 44
Practice Address - City:TRINIDAD
Practice Address - State:CA
Practice Address - Zip Code:95570
Practice Address - Country:US
Practice Address - Phone:707-845-9099
Practice Address - Fax:707-677-3575
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519060163W00000X, 163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health