Provider Demographics
NPI:1144943499
Name:PATTISON, AMANDA MARIA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA
Last Name:PATTISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-7432
Mailing Address - Country:US
Mailing Address - Phone:580-716-9384
Mailing Address - Fax:
Practice Address - Street 1:13 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4808
Practice Address - Country:US
Practice Address - Phone:580-761-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse