Provider Demographics
NPI:1285396606
Name:PRIME, PATRICIA ELIZABETH (RN, IBCLC, CPD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:PRIME
Suffix:
Gender:F
Credentials:RN, IBCLC, CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CRYSTAL RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-3645
Mailing Address - Country:US
Mailing Address - Phone:478-390-3070
Mailing Address - Fax:
Practice Address - Street 1:127 CRYSTAL RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3645
Practice Address - Country:US
Practice Address - Phone:478-390-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2-201922374J00000X
GAL-305423163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No374J00000XNursing Service Related ProvidersDoula