Healthcare Provider Details

I. General information

NPI: 1780964940
Provider Name (Legal Business Name): JENNIFER M PATTERSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 BUCKEYE RD
CLEVELAND OH
44120-2620
US

IV. Provider business mailing address

3737 LANDER RD
PEPPER PIKE OH
44124-5712
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2255
  • Fax: 216-378-3906
Mailing address:
  • Phone: 216-831-2255
  • Fax: 216-378-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.345769
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: