MEDICARE: MRS. PATRICIA MCENROE DAMATO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	360404-1	NY

General Provider Information

NPI Number	:	1710173380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA MCENROE DAMATO RN

Provider Business Mailing Address
First Line	:	484 SW COLUMBUS DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6042
Country	:	US
Telephone Number	:	772-873-3770
Fax Number	:	772-344-8690

Provider Business Practice Location Address
First Line	:	484 SW COLUMBUS DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6042
Country	:	US
Telephone Number	:	772-873-3770
Fax Number	:	772-344-8690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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