Provider Demographics
NPI:1902925233
Name:PATTISON, JANICE A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:A
Last Name:PATTISON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 GANSEVOORT BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4024
Mailing Address - Country:US
Mailing Address - Phone:718-818-5811
Mailing Address - Fax:
Practice Address - Street 1:75 VANDERBILT AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2604
Practice Address - Country:US
Practice Address - Phone:718-818-5811
Practice Address - Fax:718-818-6982
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302058363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health