Healthcare Provider Details

I. General information

NPI: 1316971955
Provider Name (Legal Business Name): PATRICIA M. MCBRIDE RNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 LIBERTY ST SE
SALEM OR
97302-4273
US

IV. Provider business mailing address

1395 LIBERTY ST SE
SALEM OR
97302-4273
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-2444
  • Fax: 503-581-3960
Mailing address:
  • Phone: 503-399-2444
  • Fax: 503-581-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number079011474N5 NMNP PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: