Provider Demographics
NPI:1497037758
Name:ACKERMAN, PATTY J (DNP, CNM, APRN)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:J
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:DNP, CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRACE
Mailing Address - State:ID
Mailing Address - Zip Code:83241-4712
Mailing Address - Country:US
Mailing Address - Phone:208-220-7111
Mailing Address - Fax:208-269-1491
Practice Address - Street 1:804 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRACE
Practice Address - State:ID
Practice Address - Zip Code:83241-4712
Practice Address - Country:US
Practice Address - Phone:208-220-7111
Practice Address - Fax:208-269-1491
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCMN61A208D00000X, 363L00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner