Provider Demographics
NPI:1881702231
Name:PATTERSON, PATRICIA DAWN (FNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DAWN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6095
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6095
Mailing Address - Country:US
Mailing Address - Phone:541-706-5922
Mailing Address - Fax:541-706-6869
Practice Address - Street 1:1253 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1334
Practice Address - Country:US
Practice Address - Phone:541-706-8131
Practice Address - Fax:541-460-4028
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR754536363LA2100X
NY341309363LF0000X
OR10012119363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115814Medicaid
LA1750379Medicaid
MS640507572WWOtherAMERICAN ADMIN GROUP
500001471Medicare ID - Type Unspecified
P00117877Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MS00115814Medicaid
LA1750379Medicaid