Provider Demographics
NPI:1295746295
Name:DEMAIO, PATRICIA (MSN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DEMAIO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CHEVY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4127
Mailing Address - Country:US
Mailing Address - Phone:541-690-3555
Mailing Address - Fax:
Practice Address - Street 1:1307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2936
Practice Address - Country:US
Practice Address - Phone:541-690-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101010363L00000X
NJ26NJ00101300363L00000X
CANP95013148363L00000X
OR201902536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435543099Medicaid
Q39059Medicare UPIN
NJ109077SUUMedicare PIN
ME435543099Medicaid
ME001567401Medicare PIN
NJ109077SBVMedicare PIN