Provider Demographics
NPI:1639996754
Name:PATTERSON, DIANA FAYE RAMOS
Entity type:Individual
Prefix:
First Name:DIANA FAYE
Middle Name:RAMOS
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 1:652 CABRA ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:916-397-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY38509364SI0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SI0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistInformatics