Healthcare Provider Details

I. General information

NPI: 1851564025
Provider Name (Legal Business Name): MRS. LADEL CARLITA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25111 CR 39
FRESNO OH
43824
US

IV. Provider business mailing address

29588 COUNTY ROAD 190
FRESNO OH
43824-9526
US

V. Phone/Fax

Practice location:
  • Phone: 740-545-6444
  • Fax:
Mailing address:
  • Phone: 740-502-1429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN. 118774 IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: