Healthcare Provider Details

I. General information

NPI: 1285283523
Provider Name (Legal Business Name): DAVID A PATTERSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 UNIVERSITY BLVD NE APT 204
ALBUQUERQUE NM
87102-1722
US

IV. Provider business mailing address

1520 UNIVERSITY BLVD NE APT 204
ALBUQUERQUE NM
87102-1722
US

V. Phone/Fax

Practice location:
  • Phone: 575-415-8335
  • Fax:
Mailing address:
  • Phone: 575-415-8335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55977
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: