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General NPI Number Information
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NPI Number | 1821745399
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Entity Type | Individual
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Provider Name | EDEN MARIE PATTERSON FNP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 34684 YALE DR
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City | YUCAIPA
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State | CA
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Zip | 92399-6874
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Country | US
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Telephone | 909-654-9558
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Fax |
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Provider Business Mailing Address
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Address Line | 34684 YALE DR
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City | YUCAIPA
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State | CA
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Zip | 92399-6874
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Country | US
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Telephone |
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F02220526
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F02220526
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License Number State | UT
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