Provider Demographics
NPI:1417551342
Name:PATRICK, CLAUDIA M
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:M
Last Name:PATRICK
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 1:284 BLACK WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9618
Mailing Address - Country:US
Mailing Address - Phone:614-558-5903
Mailing Address - Fax:
Practice Address - Street 1:284 BLACK WALNUT DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9618
Practice Address - Country:US
Practice Address - Phone:614-558-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2107801385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2107801Medicaid