Provider Demographics
NPI:1255429668
Name:PATTERSON, DEBORAH BEATTY (MMS PAC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:BEATTY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MMS PAC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:SUE
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:5500 CORPORATE DR STE 320
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5848
Practice Address - Country:US
Practice Address - Phone:412-435-1170
Practice Address - Fax:412-435-1171
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001504L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035003360001Medicaid