Basic Information
| Provider Information | |||||||||
| NPI: | 1972806743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATZ | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | FLAVELL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 MILLERS RUN RD | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150171348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126923145 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 MILLERS RUN RD | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150171348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126923145 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2010 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP011108 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1027888320001 | 05 | PA | MEDICAID |