Provider Demographics
NPI:1801230693
Name:PATTISON, EMMA R
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:R
Last Name:PATTISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:R
Other - Last Name:VERBOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 E CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6479
Mailing Address - Country:US
Mailing Address - Phone:715-832-2223
Mailing Address - Fax:715-832-7416
Practice Address - Street 1:503 E CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6479
Practice Address - Country:US
Practice Address - Phone:715-832-2223
Practice Address - Fax:715-832-7416
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4917-146247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other