1881158830 NPI number — MAYTE PATTERSON NURSE PRACTITIONER

Table of content: MAYTE PATTERSON NURSE PRACTITIONER (NPI 1881158830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881158830 NPI number — MAYTE PATTERSON NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
MAYTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1881158830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78853-1470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-773-8917
Provider Business Mailing Address Fax Number:
830-773-1892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 E ACADEMY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL RIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78840-6072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-422-3305
Provider Business Practice Location Address Fax Number:
855-458-3317
Provider Enumeration Date:
01/23/2019

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:  AP140229 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F01190262 . This is a "AMERICAN ACADEMY OF NURSE PRATITIONERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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