Provider Demographics
NPI:1992041289
Name:BRICHTA, PATRICK CHAMBON (NP-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CHAMBON
Last Name:BRICHTA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 FAIRBANKS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5395
Mailing Address - Country:US
Mailing Address - Phone:505-577-3638
Mailing Address - Fax:
Practice Address - Street 1:7201 FAIRBANKS DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5395
Practice Address - Country:US
Practice Address - Phone:505-577-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily