Provider Demographics
NPI:1164795894
Name:PATTON, TRISHA LAUREN
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:LAUREN
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 116
Mailing Address - Street 2:TRAILER COURT 46 RAVEN DRIVE, 99559
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559
Mailing Address - Country:US
Mailing Address - Phone:904-543-6997
Mailing Address - Fax:907-543-6393
Practice Address - Street 1:528 HOFFMAN DRIVE, 99559
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0528
Practice Address - Country:US
Practice Address - Phone:907-545-1554
Practice Address - Fax:907-543-6393
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7360958247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other