Provider Demographics
NPI:1225870165
Name:NICKNISH, PATRICIA F
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:NICKNISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:CLAIRE
Other - Last Name:FUESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3501 JUAN TABO BLVD NE UNIT M7
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5162
Mailing Address - Country:US
Mailing Address - Phone:210-722-2339
Mailing Address - Fax:
Practice Address - Street 1:3501 JUAN TABO BLVD NE UNIT M7
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5162
Practice Address - Country:US
Practice Address - Phone:210-722-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician