Healthcare Provider Details

I. General information

NPI: 1790789667
Provider Name (Legal Business Name): MONICA RACHELLE PATIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA RACHELLE SLAMA

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N SPRUCE ST
OGALLALA NE
69153-2465
US

IV. Provider business mailing address

2601 N SPRUCE ST.
OGALLALA NE
69153
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-3645
  • Fax: 308-284-2721
Mailing address:
  • Phone: 308-284-3645
  • Fax: 308-284-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1180
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: