Provider Demographics
NPI:1083850788
Name:MABE, PATTY LOU (CSA)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:LOU
Last Name:MABE
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LONE STAR TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BONNIEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42713-8444
Mailing Address - Country:US
Mailing Address - Phone:270-528-6333
Mailing Address - Fax:
Practice Address - Street 1:109 LONE STAR TOWER RD
Practice Address - Street 2:
Practice Address - City:BONNIEVILLE
Practice Address - State:KY
Practice Address - Zip Code:42713-8444
Practice Address - Country:US
Practice Address - Phone:270-528-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA180246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist