Provider Demographics
NPI:1669717377
Name:DOUGLASS, PATRICIA (RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 ORLEANS BLVD
Mailing Address - Street 2:ORLEANS BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2343
Mailing Address - Country:US
Mailing Address - Phone:215-831-2836
Mailing Address - Fax:215-831-2929
Practice Address - Street 1:4641 ORLEANS BLVD
Practice Address - Street 2:ORLEANS BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2343
Practice Address - Country:US
Practice Address - Phone:215-831-2836
Practice Address - Fax:215-831-2929
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN156401L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse