Provider Demographics
NPI:1063843340
Name:PATTERSON, ELZONA MAE (PMHNP)
Entity Type:Individual
Prefix:MISS
First Name:ELZONA
Middle Name:MAE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 LLEWELLYN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755
Mailing Address - Country:US
Mailing Address - Phone:301-677-8749
Mailing Address - Fax:301-677-8957
Practice Address - Street 1:2481 LLEWELLYN AVENUE
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755
Practice Address - Country:US
Practice Address - Phone:301-677-8749
Practice Address - Fax:301-677-8957
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12203000286500000X
NJ26NJ00452300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No286500000XHospitalsMilitary Hospital