Provider Demographics
NPI:1992509624
Name:PATTERSON, TREVA LYNN
Entity type:Individual
Prefix:
First Name:TREVA
Middle Name:LYNN
Last Name:PATTERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 S 109TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4617
Mailing Address - Country:US
Mailing Address - Phone:402-810-2776
Mailing Address - Fax:
Practice Address - Street 1:9018 FORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1749
Practice Address - Country:US
Practice Address - Phone:402-763-8935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide