Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 20679 | SC |
NPI | 1073043097 |
---|---|
Provider Name | Valencia Arthiena Patterson |
First Address | Atlanta, GA 30374-3904 |
Second Address | Sumter, SC 29150-4949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 10/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP5025 | (05) | SC |