Provider Demographics
NPI:1184620619
Name:PAJAK, PATRICIA (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PAJAK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-534-1155
Mailing Address - Fax:814-535-8720
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:STE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4330
Practice Address - Country:US
Practice Address - Phone:814-534-9230
Practice Address - Fax:814-534-9465
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008590L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12637Medicare UPIN
PA041640Medicare ID - Type Unspecified