Healthcare Provider Details

I. General information

NPI: 1366636110
Provider Name (Legal Business Name): VICKIE LYNN PATTERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6883 CEDAR ST
AKRON NY
14001-9663
US

IV. Provider business mailing address

6883 CEDAR ST
AKRON NY
14001-9663
US

V. Phone/Fax

Practice location:
  • Phone: 716-946-5092
  • Fax:
Mailing address:
  • Phone: 716-946-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number442176-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number442176-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: