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General NPI Number Information
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NPI Number | 1528466190
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Entity Type | Individual
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Provider Name | PETRA PATTERSON RN OWNER
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Gender | Female
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 7700 OLD BRANCH AVE
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 301-856-7222
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Fax | 301-856-2786
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Provider Business Mailing Address
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Address Line | 7700 OLD BRANCH AVE
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 301-856-7222
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Fax | 301-856-2786
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | R130430
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License Number State | MD
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