Provider Demographics
NPI:1851506075
Name:ETHRIDGE, PATRICIA A (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 SAMUEL MORSE DRIVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7055 SAMUEL MORSE DRIVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3441
Practice Address - Country:US
Practice Address - Phone:410-910-6713
Practice Address - Fax:410-910-6627
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR085252163W00000X
MDR85252163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator