MEDICARE: DIANE PATTERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	066533	OH

General Provider Information

NPI Number	:	1013450063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE PATTERSON

Provider Business Mailing Address
First Line	:	6460 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7957
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-941-7555

Provider Business Practice Location Address
First Line	:	6460 HARRISON AVE STE 100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7958
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	11/05/2018

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