Provider Demographics
NPI:1962452227
Name:ABBOTT, PATRICIA D (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:D
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12348 E MONTVIEW BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7103
Practice Address - Country:US
Practice Address - Phone:303-724-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990469-NP363LF0000X, 363LF0000X
WAAP30002314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU87061OtherREGENCE BLUESHIELD
WA0155913OtherLABOR & INDUSTRY
WA9632183Medicaid
WAU87061OtherREGENCE BLUESHIELD
WAAB07789Medicare ID - Type UnspecifiedMEDICARE