Provider Demographics
NPI:1639762164
Name:PATTERSON, JULIE (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W321S8960 LEAH WAY
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8257
Mailing Address - Country:US
Mailing Address - Phone:414-215-9646
Mailing Address - Fax:
Practice Address - Street 1:W321S8960 LEAH WAY
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8257
Practice Address - Country:US
Practice Address - Phone:414-215-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115902-30163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty