Provider Demographics
NPI:1124208632
Name:PATTON, WANDA L (RRT, RCP)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:PATTON
Suffix:
Gender:F
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 N BAKER RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-9509
Mailing Address - Country:US
Mailing Address - Phone:812-897-3211
Mailing Address - Fax:812-897-5400
Practice Address - Street 1:1215 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-6807
Practice Address - Country:US
Practice Address - Phone:812-475-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30003630A227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30003630AOtherSTATE LICENSE