Provider Demographics
NPI:1922140466
Name:PATRIDGE, VICKI ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:ANN
Last Name:PATRIDGE
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:CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:
Practice Address - Street 1:COLEMAN HEALTH CLINIC
Practice Address - Street 2:CMR 418
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09058
Practice Address - Country:DE
Practice Address - Phone:490621-779-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN130109163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care