MEDICARE: NICOLE M 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	363LF0000X	Family Nurse Practitioner	71009633A	IN

General Provider Information

NPI Number	:	1871139014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE M PATTERSON

Provider Business Mailing Address
First Line	:	1100 REID PARKWAY
Second Line	:	MEDICAL STAFF SERVCIES
City	:	RICHMOND
State	:	IN
Zip	:	47374
Country	:	US
Telephone Number	:	765-935-8802
Fax Number	:	765-983-3219

Provider Business Practice Location Address
First Line	:	1154 S STATE ROAD 1 STE 1
Second Line	:
City	:	CAMBRIDGE CITY
State	:	IN
Zip	:	47327-9513
Country	:	US
Telephone Number	:	765-478-6108
Fax Number	:	765-478-1243

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

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	01/07/2022

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Directions to “ NICOLE M PATTERSON ” Practice Location

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