Healthcare Provider Details

I. General information

NPI: 1437563152
Provider Name (Legal Business Name): NINA PATYNOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W SOFIA ST STE 100
CARSON CITY NV
89703
US

IV. Provider business mailing address

535 CORTONO DR
RENO NV
89521-4293
US

V. Phone/Fax

Practice location:
  • Phone: 775-841-5530
  • Fax:
Mailing address:
  • Phone: 775-857-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001746
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: