Healthcare Provider Details

I. General information

NPI: 1225216294
Provider Name (Legal Business Name): SANDRA ANN MARIE PATTERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PASCALE PL
MARLBORO NY
12542-5232
US

IV. Provider business mailing address

30 PASCALE PL
MARLBORO NY
12542-5232
US

V. Phone/Fax

Practice location:
  • Phone: 845-240-8906
  • Fax:
Mailing address:
  • Phone: 845-240-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782460
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2914611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: