Provider Demographics
NPI:1033554696
Name:MANN, PATRICH (RN)
Entity type:Individual
Prefix:MRS
First Name:PATRICH
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LEVON OWENS DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-9696
Mailing Address - Country:US
Mailing Address - Phone:601-720-5460
Mailing Address - Fax:601-878-0687
Practice Address - Street 1:118 LEVON OWENS DR
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-9696
Practice Address - Country:US
Practice Address - Phone:601-720-5460
Practice Address - Fax:601-878-0687
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866849163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health