Provider Demographics
NPI:1386245025
Name:PATTON, VIRGINIA A
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:A
Last Name:PATTON
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 1:40560 BURLINGHAM RD BSMT
Mailing Address - Street 2:
Mailing Address - City:SHADE
Mailing Address - State:OH
Mailing Address - Zip Code:45776-9556
Mailing Address - Country:US
Mailing Address - Phone:740-591-7333
Mailing Address - Fax:
Practice Address - Street 1:40560 BURLINGHAM RD BSMT
Practice Address - Street 2:
Practice Address - City:SHADE
Practice Address - State:OH
Practice Address - Zip Code:45776-9556
Practice Address - Country:US
Practice Address - Phone:740-591-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM0501442Medicaid