Healthcare Provider Details

I. General information

NPI: 1750861621
Provider Name (Legal Business Name): JOSEPH DAVID PATACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7253 GROVER ST
OMAHA NE
68124-3580
US

IV. Provider business mailing address

7253 GROVER ST
OMAHA NE
68124-3580
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-2492
  • Fax:
Mailing address:
  • Phone: 402-390-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number112557
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number112557
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number112557
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: