Provider Demographics
NPI:1669052692
Name:STRONG, PATRICIA M
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:STRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MINCK
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:CA
Mailing Address - Zip Code:92036-0759
Mailing Address - Country:US
Mailing Address - Phone:619-851-4680
Mailing Address - Fax:
Practice Address - Street 1:3509 DEER LAKE PARK ROAD
Practice Address - Street 2:
Practice Address - City:JULIAN
Practice Address - State:CA
Practice Address - Zip Code:92036-9203
Practice Address - Country:US
Practice Address - Phone:619-851-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396390251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care