Provider Demographics
NPI:1265570899
Name:WETSELL, PATRICIA A (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:WETSELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2544
Mailing Address - Country:US
Mailing Address - Phone:631-924-5060
Mailing Address - Fax:631-924-8690
Practice Address - Street 1:606 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2544
Practice Address - Country:US
Practice Address - Phone:631-924-5060
Practice Address - Fax:631-924-8690
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical