Provider Demographics
NPI:1962128025
Name:PATTEN, MARY (BSN, RN, DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:PATTEN
Suffix:
Gender:F
Credentials:BSN, RN, DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E SPAULDING AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1668
Mailing Address - Country:US
Mailing Address - Phone:719-281-1605
Mailing Address - Fax:719-988-9677
Practice Address - Street 1:44 E SPAULDING AVE STE 3
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1668
Practice Address - Country:US
Practice Address - Phone:719-281-1605
Practice Address - Fax:719-988-9677
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1685232163W00000X
CO0998187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse