Basic Information
Provider Information | |||||||||
NPI: | 1851531842 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAZURI | ||||||||
FirstName: | PATRICIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSYD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HAMMOND | ||||||||
OtherFirstName: | PATRICIA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2817 REILLY RD | ||||||||
Address2: | WOMACK ARMY MEDICAL CENTER | ||||||||
City: | FORT BRAGG | ||||||||
State: | NC | ||||||||
PostalCode: | 28310 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9109078922 | ||||||||
FaxNumber: | 9109076069 | ||||||||
Practice Location | |||||||||
Address1: | 9040 JACKSON AVE | ||||||||
Address2: | MADIGAN ARMY MEDICAL CENTER | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 98431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2534772546 | ||||||||
FaxNumber: | 9109076069 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/03/2009 | ||||||||
LastUpdateDate: | 09/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY60065054 | WA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.