Provider Demographics
NPI:1083659536
Name:MAHER-MEDIUCH, PATRICIA (RN, APN, C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:MAHER-MEDIUCH
Suffix:
Gender:F
Credentials:RN, APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RABBIT RUN
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-4423
Mailing Address - Country:US
Mailing Address - Phone:609-463-9797
Mailing Address - Fax:609-463-9798
Practice Address - Street 1:605 ROUTE 9 S STE 3
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2343
Practice Address - Country:US
Practice Address - Phone:609-665-6242
Practice Address - Fax:609-463-9798
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC10613300364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020538093OtherEMPLOYER IDENTIFICATION N
NJ020538093OtherEMPLOYER IDENTIFICATION N
NJ054708Medicare PIN