Provider Demographics
NPI:1932510781
Name:WASHINGTON, PATRICIA (STNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19203 KEWANEE AVE APT UP
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2748
Mailing Address - Country:US
Mailing Address - Phone:216-450-8334
Mailing Address - Fax:
Practice Address - Street 1:19203 KEWANEE AVE APT UP
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2748
Practice Address - Country:US
Practice Address - Phone:216-450-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400987081009171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3140792Medicaid