MEDICARE: EEAN 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	246QM0706X	Medical Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6776668887	OTHER	AZ	EARLY INTERVENTION PROVIDER

General Provider Information

NPI Number	:	1538876214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EEAN PATTERSON

Provider Business Mailing Address
First Line	:	3623 N 5TH AVE # 23B1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3703
Country	:	US
Telephone Number	:	518-596-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 N 5TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2289
Country	:	US
Telephone Number	:	518-596-6100
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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Directions to “ EEAN PATTERSON ” Practice Location

Language	Start Address	Practice Location

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