Provider Demographics
NPI:1578787974
Name:PATKO, LAUREEN MARIE
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:MARIE
Last Name:PATKO
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 1:820 CHAUCER LN
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9337
Mailing Address - Country:US
Mailing Address - Phone:937-339-3058
Mailing Address - Fax:937-849-0308
Practice Address - Street 1:550 SURREY DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2207
Practice Address - Country:US
Practice Address - Phone:937-506-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668644Medicaid