Provider Demographics
NPI:1184193484
Name:WADE-PATTON, LOREAL
Entity Type:Individual
Prefix:
First Name:LOREAL
Middle Name:
Last Name:WADE-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 1:1517 SANTA ROSALIA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1010
Mailing Address - Country:US
Mailing Address - Phone:702-929-3297
Mailing Address - Fax:702-750-9927
Practice Address - Street 1:1517 SANTA ROSALIA DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1010
Practice Address - Country:US
Practice Address - Phone:702-929-3297
Practice Address - Fax:702-750-9927
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health