Basic Information
| Provider Information | |||||||||
| NPI: | 1316092380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTEN | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | RN CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 193 LOCUST ST. | ||||||||
| Address2: | STE. 2 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135841714 | ||||||||
| Practice Location | |||||||||
| Address1: | 193 LOCUST ST. | ||||||||
| Address2: | STE. 2 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135841714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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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 | 363LF0000X | 191085 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP9976 | 01 | MA | MABCBS PROVIDER NUMBER | OTHER |