Provider Demographics
NPI:1538462726
Name:PATTERSON, BECKY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:MARIE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:MARIE
Other - Last Name:WIPPERFURTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:W12968 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-9789
Mailing Address - Country:US
Mailing Address - Phone:608-592-5078
Mailing Address - Fax:
Practice Address - Street 1:W12968 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-9789
Practice Address - Country:US
Practice Address - Phone:608-592-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12894830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse