Provider Demographics
NPI:1972806743
Name:PATZ, BARBARA FLAVELL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:FLAVELL
Last Name:PATZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MILLERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1348
Mailing Address - Country:US
Mailing Address - Phone:412-692-3145
Mailing Address - Fax:
Practice Address - Street 1:205 MILLERS RUN RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1348
Practice Address - Country:US
Practice Address - Phone:412-692-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027888320001Medicaid