Provider Demographics
NPI:1356546105
Name:VANDERPOOL, PATRICIA JOANN (DNP, FNP-BC, ANP-BC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JOANN
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:DNP, FNP-BC, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4355
Mailing Address - Country:US
Mailing Address - Phone:765-836-5047
Mailing Address - Fax:765-591-8171
Practice Address - Street 1:1516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4355
Practice Address - Country:US
Practice Address - Phone:765-836-5047
Practice Address - Fax:765-591-8171
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002447B363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200879950BMedicaid
IN1514145535003Medicare PIN