Provider Demographics
NPI:1730153735
Name:PAVLICK, PATRICIA D (FNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:D
Last Name:PAVLICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:607-962-5102
Practice Address - Street 1:123 CONHOCTON ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2911
Practice Address - Country:US
Practice Address - Phone:607-962-5402
Practice Address - Fax:607-962-1502
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8362OtherRR MEDICARE GROUP
NYP00387773OtherRR MEDICARE PIN
NY02679270Medicaid
NYRA8246Medicare ID - Type Unspecified
NYCC8362OtherRR MEDICARE GROUP