Provider Demographics
NPI:1093202178
Name:PATTEN, ANGELA (RD, CSG, CDCES)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PATTEN
Suffix:
Gender:F
Credentials:RD, CSG, CDCES
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:ABBASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:29100 NORTHWESTERN HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1091
Mailing Address - Country:US
Mailing Address - Phone:248-357-2255
Mailing Address - Fax:
Practice Address - Street 1:29100 NORTHWESTERN HWY STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1091
Practice Address - Country:US
Practice Address - Phone:248-357-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1062403133VN1101X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological