Provider Demographics
NPI:1508032830
Name:PATTON, NIELA VICNESHA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:NIELA
Middle Name:VICNESHA
Last Name:PATTON
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 1:10323 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3214
Mailing Address - Country:US
Mailing Address - Phone:216-854-3646
Mailing Address - Fax:
Practice Address - Street 1:10323 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3214
Practice Address - Country:US
Practice Address - Phone:216-854-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126146 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2816742Medicaid