Healthcare Provider Details

I. General information

NPI: 1306365549
Provider Name (Legal Business Name): IRIS C PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HANSON PL
KENNER LA
70062-7124
US

IV. Provider business mailing address

7838 BASS ST
NEW ORLEANS LA
70128
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 504-223-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number006942851
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: