Healthcare Provider Details

I. General information

NPI: 1669822847
Provider Name (Legal Business Name): PATRESHA PAMELLA PEARSON MSN BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRESHA LAVORGNA RN

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E KNOX RD LOT 44
CHANDLER AZ
85225-3325
US

IV. Provider business mailing address

200 E KNOX RD LOT 44
CHANDLER AZ
85225-3325
US

V. Phone/Fax

Practice location:
  • Phone: 760-402-6788
  • Fax:
Mailing address:
  • Phone: 760-402-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberRN 127955
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number631334
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number127955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: