Healthcare Provider Details

I. General information

NPI: 1396774709
Provider Name (Legal Business Name): PATRICIA BATES RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ACADEMY ST
BOONVILLE NY
13309-1397
US

IV. Provider business mailing address

6336 PLEASANT DR
ROME NY
13440-7439
US

V. Phone/Fax

Practice location:
  • Phone: 315-942-4301
  • Fax:
Mailing address:
  • Phone: 315-339-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: