Provider Demographics
NPI:1124210836
Name:PATTERSON, SHENA
Entity type:Individual
Prefix:
First Name:SHENA
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 1:3532 FIELDCREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3424
Mailing Address - Country:US
Mailing Address - Phone:315-542-8106
Mailing Address - Fax:
Practice Address - Street 1:3300 N RIDGE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3383
Practice Address - Country:US
Practice Address - Phone:410-750-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP36688164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse