MEDICARE: MS. LATAWANA PATTERSON RN

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	163W00000X	Registered Nurse	2012011701	MO

General Provider Information

NPI Number	:	1730571589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATAWANA PATTERSON RN

Provider Business Mailing Address
First Line	:	3947 JANE AVE
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-1911
Country	:	US
Telephone Number	:	314-686-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	3947 JANE AVE
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-1911
Country	:	US
Telephone Number	:	314-686-3493
Fax Number	:

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

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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