Provider Demographics
NPI:1730077256
Name:PATTERSON, TRAVIS LEVI
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:LEVI
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 KALAMAZOO AVE SE APT 209
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3968
Mailing Address - Country:US
Mailing Address - Phone:805-222-0032
Mailing Address - Fax:
Practice Address - Street 1:2619 KALAMAZOO AVE SE APT 209
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3968
Practice Address - Country:US
Practice Address - Phone:805-222-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No172A00000XOther Service ProvidersDriver