MEDICARE: AYESHA PATTERSON LPN,IBCLC

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1659991008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESHA PATTERSON LPN,IBCLC

Provider Business Mailing Address
First Line	:	5045 FOXDALE DR
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-2234
Country	:	US
Telephone Number	:	646-275-4982
Fax Number	:

Provider Business Practice Location Address
First Line	:	5045 FOXDALE DR
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-2234
Country	:	US
Telephone Number	:	646-275-4982
Fax Number	:

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

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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