Healthcare Provider Details

I. General information

NPI: 1760547905
Provider Name (Legal Business Name): MICHELLE LYNN PATTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE JEFFERS

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 WINNEMAC RD
RICHWOOD OH
43344
US

IV. Provider business mailing address

30455 LEMASTERS RD
RICHWOOD OH
43344-9711
US

V. Phone/Fax

Practice location:
  • Phone: 740-943-5339
  • Fax:
Mailing address:
  • Phone: 740-943-2656
  • Fax: 740-943-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberNP094830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: