1689609752 NPI number — MRS. PATRICIA MARIE OKONIEWSKI FNP

Table of content: MRS. PATRICIA MARIE OKONIEWSKI FNP (NPI 1689609752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689609752 NPI number — MRS. PATRICIA MARIE OKONIEWSKI FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKONIEWSKI
Provider First Name:
PATRICIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRETT
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689609752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78 RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13069-3317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-592-2752
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
453 PARK STREET
Provider Second Line Business Practice Location Address:
MICHAUD RESIDENTIAL HEALTH SERVICE
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13069-3317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-592-2009
Provider Business Practice Location Address Fax Number:
315-592-2942
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F3307791 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 9220216 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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