Provider Demographics
NPI:1790789667
Name:PATIN, MONICA RACHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:RACHELLE
Last Name:PATIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RACHELLE
Other - Last Name:SLAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2601 N SPRUCE ST.
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153
Mailing Address - Country:US
Mailing Address - Phone:308-284-3645
Mailing Address - Fax:308-284-2721
Practice Address - Street 1:2601 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2465
Practice Address - Country:US
Practice Address - Phone:308-284-3645
Practice Address - Fax:308-284-2721
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1180363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055808700Medicaid
NE280925Medicare PIN
NENA1456011Medicare PIN
NE47055808700Medicaid