Provider Demographics
NPI:1417507864
Name:SAMILTON, PATRICE PATRICIA (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:PATRICIA
Last Name:SAMILTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1603
Mailing Address - Country:US
Mailing Address - Phone:216-372-5538
Mailing Address - Fax:
Practice Address - Street 1:1109 E 66TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1603
Practice Address - Country:US
Practice Address - Phone:216-372-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health