Provider Demographics
NPI:1740469642
Name:PATTERSON, KATHERINE KOIKE (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:KOIKE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:KOIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3205 CINIZA DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4618
Mailing Address - Country:US
Mailing Address - Phone:505-722-1756
Mailing Address - Fax:505-722-1310
Practice Address - Street 1:516 NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5748
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-722-1310
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17335163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health