Basic Information
Provider Information
NPI: 1457319261
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOFZINGER
FirstName: PATRICIA
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3707 DOTY RD
Address2:  
City: WOODSTOCK
State: IL
PostalCode: 60098
CountryCode: US
TelephoneNumber: 8153386600
FaxNumber:  
Practice Location
Address1: 3707 DOTY RD
Address2: SUITE H
City: WOODSTOCK
State: IL
PostalCode: 600987530
CountryCode: US
TelephoneNumber: 8153386600
FaxNumber: 8153375491
Other Information
ProviderEnumerationDate: 05/02/2006
LastUpdateDate: 08/02/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X036085643ILY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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