Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01077847A | IN |
N | 208600000X | Surgeon | 01077847A | IN |
N | 208200000X | Surgeon | 33819 | SC |
N | 208600000X | Surgeon | 33819 | SC |
Y | 208200000X | Surgeon | MD-46283 | IA |
Y | 208600000X | Surgeon | MD-46283 | IA |
N | 2086S0102X | Surgical Critical Care | MD-46283 | IA |
N | 2086S0127X | Trauma Surgeon | 01077847A | IN |
NPI | 1225323348 |
---|---|
Provider Name | Alicia Patterson |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300017420 | (05) | IN |