Provider Demographics
NPI:1417663378
Name:PATTERSON, ROBERTA (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROAD RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-4221
Mailing Address - Country:US
Mailing Address - Phone:843-592-4635
Mailing Address - Fax:
Practice Address - Street 1:1 BROAD RIVER BLVD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4221
Practice Address - Country:US
Practice Address - Phone:843-592-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management