Provider Demographics
NPI:1174089122
Name:PATRIE, CHRISTIE LYNN
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYNN
Last Name:PATRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1206
Mailing Address - Country:US
Mailing Address - Phone:419-520-3853
Mailing Address - Fax:
Practice Address - Street 1:40 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1206
Practice Address - Country:US
Practice Address - Phone:419-520-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.268601163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263910Medicaid
OH1790735462OtherNPI