Healthcare Provider Details

I. General information

NPI: 1780204941
Provider Name (Legal Business Name): ZELDA RAE PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 EDER TERRACE
SOUTH ORANGE NJ
07079-2508
US

IV. Provider business mailing address

36 EDER TERRACE
SOUTH ORANGE NJ
07079-2508
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-7356
  • Fax:
Mailing address:
  • Phone: 973-762-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ00496100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ00496100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: