Provider Demographics
NPI:1043038813
Name:PATTERSON, MISTYDAWN (PMH-BC, RN)
Entity type:Individual
Prefix:
First Name:MISTYDAWN
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PMH-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 S CRAMER CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8931
Mailing Address - Country:US
Mailing Address - Phone:812-272-0525
Mailing Address - Fax:
Practice Address - Street 1:3961 S CRAMER CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-8931
Practice Address - Country:US
Practice Address - Phone:812-272-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28270730A163WG0000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice