Provider Demographics
NPI:1659507044
Name:DOUGLAS, PATRICIA WRIGHT (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WRIGHT
Last Name:DOUGLAS
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 1:44 E BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2601
Mailing Address - Country:US
Mailing Address - Phone:678-471-8055
Mailing Address - Fax:937-723-8217
Practice Address - Street 1:44 E BRUCE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2601
Practice Address - Country:US
Practice Address - Phone:678-471-8055
Practice Address - Fax:937-723-8217
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 072392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse