Provider Demographics
NPI:1831399401
Name:NELSON, PATRICIA JOAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865-9740
Mailing Address - Country:US
Mailing Address - Phone:607-535-7121
Mailing Address - Fax:607-535-4433
Practice Address - Street 1:220 STEUBEN ST
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865-9740
Practice Address - Country:US
Practice Address - Phone:607-535-7121
Practice Address - Fax:607-535-4433
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011887-1363A00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03065643Medicaid
NYJ400000638Medicare PIN
NY03065643Medicaid
NYPA2496Medicare PIN