Provider Demographics
NPI:1427763697
Name:SCURLOCK, PATRINA L
Entity type:Individual
Prefix:
First Name:PATRINA
Middle Name:L
Last Name:SCURLOCK
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 1:30575 OAKLEAF LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1466
Mailing Address - Country:US
Mailing Address - Phone:313-350-1082
Mailing Address - Fax:
Practice Address - Street 1:8925 APPOLINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2625
Practice Address - Country:US
Practice Address - Phone:313-350-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse