Healthcare Provider Details

I. General information

NPI: 1215663034
Provider Name (Legal Business Name): DAMIKA PATTERSON REGISTERED NUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MAIN ST
TONAWANDA NY
14150-3816
US

IV. Provider business mailing address

412 MAIN ST
TONAWANDA NY
14150-3816
US

V. Phone/Fax

Practice location:
  • Phone: 716-936-4928
  • Fax:
Mailing address:
  • Phone: 716-936-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: