Healthcare Provider Details

I. General information

NPI: 1932626728
Provider Name (Legal Business Name): NIKA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARCELA DR
WILLITS CA
95490-5769
US

IV. Provider business mailing address

1 MARCELA DR
WILLITS CA
95490-5769
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-6801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: