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General NPI Number Information
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NPI Number | 1164795894
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Entity Type | Individual
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Provider Name | MISS TRISHA LAUREN PATTON
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Gender | Female
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 528 HOFFMAN DRIVE, 99559
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City | BETHEL
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State | AK
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Zip | 99559-0528
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Country | US
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Telephone | 907-545-1554
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Fax | 907-543-6393
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Provider Business Mailing Address
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Address Line | P.O. BOX 116 TRAILER COURT 46 RAVEN DRIVE, 99559
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City | BETHEL
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State | AK
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Zip | 99559
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Country | US
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Telephone | 904-543-6997
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Fax | 907-543-6393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 7360958
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License Number State | AK
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