Provider Demographics
NPI:1891311031
Name:PATTERSON, REANNA
Entity Type:Individual
Prefix:
First Name:REANNA
Middle Name:
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 1:40 GARVIN PARK
Mailing Address - Street 2:
Mailing Address - City:DIANA
Mailing Address - State:WV
Mailing Address - Zip Code:26217-4501
Mailing Address - Country:US
Mailing Address - Phone:304-847-5905
Mailing Address - Fax:
Practice Address - Street 1:804 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1796
Practice Address - Country:US
Practice Address - Phone:130-487-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist