Provider Demographics
NPI:1225706922
Name:PATTERSON, STACEY SR
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:PATTERSON
Suffix:SR
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 1:586 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5904
Mailing Address - Country:US
Mailing Address - Phone:740-405-2667
Mailing Address - Fax:
Practice Address - Street 1:586 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5904
Practice Address - Country:US
Practice Address - Phone:740-405-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker