1760782700 NPI number — MS. PATTY ANN MCDONOUGH REGISTERED NURSE

Table of content: MS. PATTY ANN MCDONOUGH REGISTERED NURSE (NPI 1760782700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760782700 NPI number — MS. PATTY ANN MCDONOUGH REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONOUGH
Provider First Name:
PATTY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760782700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 992
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRINIDAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95570-0992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-845-9099
Provider Business Mailing Address Fax Number:
707-677-3575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 MIDWAY DRIVE
Provider Second Line Business Practice Location Address:
SPACE 44
Provider Business Practice Location Address City Name:
TRINIDAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-845-9099
Provider Business Practice Location Address Fax Number:
707-677-3575
Provider Enumeration Date:
10/25/2010

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: 163W00000X , with the licence number:  519060 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC0400X , with the licence number: 519060 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WH0200X , with the licence number: 519060 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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