Provider Demographics
NPI:1972016178
Name:GROGAN, PATRICIA SHANNON (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SHANNON
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C CHELSEA RDIGE DR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590
Mailing Address - Country:US
Mailing Address - Phone:845-440-6804
Mailing Address - Fax:
Practice Address - Street 1:230 NORTH ROAD
Practice Address - Street 2:DUTCHESS COUNTY DEPARTMENT MENTAL HEALTH STABILIZATION
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-486-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259970-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse