MEDICARE: VICKI ANN PATTERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	346923	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	346923	OTHER		CA BOARD OF REGISTERED NU
2	4261	OTHER		CA BOARD OF REGISTERED NU

General Provider Information

NPI Number	:	1801861737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI ANN PATTERSON NP

Provider Business Mailing Address
First Line	:	PO BOX 1090
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95241-1090
Country	:	US
Telephone Number	:	209-334-1800
Fax Number	:	209-334-2416

Provider Business Practice Location Address
First Line	:	1617 N CALIFORNIA ST
Second Line	:	STE. 2A
City	:	STOCKTON
State	:	CA
Zip	:	95204-6117
Country	:	US
Telephone Number	:	209-466-8546
Fax Number	:	209-466-3335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/07/2023

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Directions to “ VICKI ANN PATTERSON NP” Practice Location

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