Provider Demographics
NPI:1881184091
Name:PATROW, TABETHA CHRISTY (MNS, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TABETHA
Middle Name:CHRISTY
Last Name:PATROW
Suffix:
Gender:F
Credentials:MNS, NP-C
Other - Prefix:MISS
Other - First Name:TABETHA
Other - Middle Name:CHRISTY
Other - Last Name:KOVALASKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15194 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5156
Mailing Address - Country:US
Mailing Address - Phone:715-559-5769
Mailing Address - Fax:
Practice Address - Street 1:3940 OAKWOOD HILLS PKWY STE 2
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8888
Practice Address - Country:US
Practice Address - Phone:715-552-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8407-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner