Provider Demographics
NPI:1811176803
Name:PATERSON, ANITA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PATERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E PROSPECT AVE
Mailing Address - Street 2:1-A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1651
Mailing Address - Country:US
Mailing Address - Phone:718-547-3504
Mailing Address - Fax:
Practice Address - Street 1:255 E PROSPECT AVE
Practice Address - Street 2:1-A
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1651
Practice Address - Country:US
Practice Address - Phone:718-547-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02901733Medicaid