Doctor Name: | MS. STACIE LYN PATTERSON |
NPI Number: | 1053430876 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 5601004376 |
Business Practice Address: | 13677 W. Mc Dowell Road 201 Goodyear, AZ - 85395 |
Business Phone Number: | 6238821926 |
Business Fax Number: | 6238821709 |
Mailing Address: | 13677 W. Mc Dowell Road, Ste 201 GOODYEAR |
State: | AZ |
Postal Code: | 85395 |
Phone Number: | 6238821926 |
Fax Number: | 6238821709 |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601004376 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |