Provider Demographics
NPI:1497182885
Name:PATTON, CAROLYN YVONNE (ACNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:YVONNE
Last Name:PATTON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23121 RADCLIFT ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2478
Mailing Address - Country:US
Mailing Address - Phone:313-333-9724
Mailing Address - Fax:
Practice Address - Street 1:23121 RADCLIFT ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2478
Practice Address - Country:US
Practice Address - Phone:313-333-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244541363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704244541OtherSTATE OF MICHIGAN