Basic Information
| Provider Information | |||||||||
| NPI: | 1225156995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAK | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015500040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089097799 | ||||||||
| FaxNumber: | 5087642432 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 MAIN ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | STURBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015661556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083477585 | ||||||||
| FaxNumber: | 5083477538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | R38709 | CT | N | Nursing Service Providers | Registered Nurse | Diabetes Educator | 163WD0400X | RN145129 | MA | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.