Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO5760 | FL |
NPI | 1194952572 |
---|---|
Provider Name | Nancy Bragaw Patten |
First Address | Fort Myers, FL 33907-7543 |
Second Address | Fort Myers, FL 33907-7543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2009 |
Last Update Date | 24/03/2011 |