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General NPI Number Information
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NPI Number | 1164265096
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Entity Type | Organization
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Legal Business Name | PATRIOT HEALTHCARE LLC
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | W2058 SPRING CREEK RD
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City | DURAND
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State | WI
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Zip | 54736-8107
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Country | US
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Telephone | 715-495-0404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13
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City | WABASHA
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State | MN
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Zip | 55981-0013
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Country | US
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Telephone | 715-279-3956
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALISON DELONG
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Credential |
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Telephone | 715-495-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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