Healthcare Provider Details

I. General information

NPI: 1023241296
Provider Name (Legal Business Name): PATRICIA G. MCBRIDE RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E COTATI AVE SONOMA STATE UNIVERSITY
ROHNERT PARK CA
94928-3613
US

IV. Provider business mailing address

108 RANCHO BONITO CIR
PETALUMA CA
94954-5622
US

V. Phone/Fax

Practice location:
  • Phone: 707-664-2921
  • Fax: 707-664-2925
Mailing address:
  • Phone: 707-763-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number176783
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: