Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN077196 AP03525 | LA |
NPI | 1043220247 |
---|---|
Provider Name | Mr. Michael Dale Patterson |
First Address | Shreveport, LA 71101-4243 |
Second Address | Shreveport, LA 71101-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |