Provider Demographics
NPI:1154708345
Name:PATTERSON, RAVEN
Entity type:Individual
Prefix:MISS
First Name:RAVEN
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 1:2425 NAYLOR RD SE
Mailing Address - Street 2:APT 4, SE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4548
Mailing Address - Country:US
Mailing Address - Phone:202-270-8573
Mailing Address - Fax:
Practice Address - Street 1:2425 NAYLOR RD SE
Practice Address - Street 2:APT 4, SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4548
Practice Address - Country:US
Practice Address - Phone:202-270-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10666374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide