Provider Demographics
NPI:1225630361
Name:PATTEN, WAYNE LOVELL SR
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:LOVELL
Last Name:PATTEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3327
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-3327
Mailing Address - Country:US
Mailing Address - Phone:701-833-3741
Mailing Address - Fax:
Practice Address - Street 1:1025 VALLEY ST
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4859
Practice Address - Country:US
Practice Address - Phone:701-833-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant