Healthcare Provider Details

I. General information

NPI: 1417002205
Provider Name (Legal Business Name): PATRICIA ANN RELFORD SA-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 SAN MILANO PL
LEXINGTON KY
40509-4531
US

IV. Provider business mailing address

2416 SAN MILANO PL
LEXINGTON KY
40509-4531
US

V. Phone/Fax

Practice location:
  • Phone: 859-433-3963
  • Fax: 859-260-4131
Mailing address:
  • Phone: 859-433-3963
  • Fax: 859-260-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA060
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: