Provider Demographics
NPI:1851564025
Name:PATTERSON, LADEL CARLITA
Entity Type:Individual
Prefix:MRS
First Name:LADEL
Middle Name:CARLITA
Last Name:PATTERSON
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 1:29588 COUNTY ROAD 190
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:OH
Mailing Address - Zip Code:43824-9526
Mailing Address - Country:US
Mailing Address - Phone:740-502-1429
Mailing Address - Fax:
Practice Address - Street 1:25111 CR 39
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:OH
Practice Address - Zip Code:43824
Practice Address - Country:US
Practice Address - Phone:740-545-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 118774 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse