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NPI Code Detail

MEDICARE: TERISSA PATTERSON

MEDICARE:   TERISSA  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
1164W00000XLicensed Practical Nurse0002056078VA

General Provider Information

NPI Number : 1275934317
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERISSA PATTERSON
Provider Business Mailing Address
First Line : 51 GOLDEN BIRCH DR
Second Line :
City : FORT STEWART
State : GA
Zip : 31315-2714
Country : US
Telephone Number : 253-219-8656
Fax Number :
Provider Business Practice Location Address
First Line : 51 GOLDEN BIRCH DR
Second Line :
City : FORT STEWART
State : GA
Zip : 31315-2714
Country : US
Telephone Number : 253-219-8656
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2014
Last Update Date : 09/09/2014

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Directions to “ TERISSA PATTERSON ” Practice Location

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