Provider Demographics
NPI:1871153668
Name:ADETORO, PATRICE MONIQUE (RN)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:MONIQUE
Last Name:ADETORO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:MONIQUE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13500 NOEL RD APT 131
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5057
Mailing Address - Country:US
Mailing Address - Phone:414-625-0775
Mailing Address - Fax:
Practice Address - Street 1:13500 NOEL RD APT 131
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5057
Practice Address - Country:US
Practice Address - Phone:414-625-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WI192968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty