Provider Demographics
NPI:1043460603
Name:PATNODE, REBECCA ANN (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:PATNODE
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 1:6217 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:BASCOM
Mailing Address - State:FL
Mailing Address - Zip Code:32423-9043
Mailing Address - Country:US
Mailing Address - Phone:850-569-5763
Mailing Address - Fax:
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3183152163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse