Healthcare Provider Details

I. General information

NPI: 1073459350
Provider Name (Legal Business Name): NICOLE A PATTERSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN ST
NORWICH CT
06360-5760
US

IV. Provider business mailing address

2 WATERSIDE XING STE 401
WINDSOR CT
06095-1588
US

V. Phone/Fax

Practice location:
  • Phone: 860-731-5522
  • Fax: 860-731-5536
Mailing address:
  • Phone: 860-731-5522
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number46973
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: