Healthcare Provider Details

I. General information

NPI: 1164708889
Provider Name (Legal Business Name): ALICIA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 ABERDEEN RD APT R7
HAMPTON VA
23661-1836
US

IV. Provider business mailing address

649 ABERDEEN RD APT R7
HAMPTON VA
23661-1836
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-1402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: