Provider Demographics
NPI:1255991394
Name:PATTERSON, ERICA ALLEN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ALLEN
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:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35670-0102
Mailing Address - Country:US
Mailing Address - Phone:256-280-7994
Mailing Address - Fax:
Practice Address - Street 1:2099 NEW CENTER RD LOT B
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:AL
Practice Address - Zip Code:35670-3887
Practice Address - Country:US
Practice Address - Phone:256-280-7994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL464122992OtherNON SKILLED CARE