Basic Information
| Provider Information | |||||||||
| NPI: | 1306277686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKIERNAN | ||||||||
| FirstName: | PATRIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 MANGROVE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959263509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303450064 | ||||||||
| FaxNumber: | 5303450680 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 MANGROVE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959263509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303450064 | ||||||||
| FaxNumber: | 5303450680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2013 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 23798 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.