Provider Demographics
NPI:1871999128
Name:PATTERSON, JANICE (CXT(C))
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CXT(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 STATE ST
Mailing Address - Street 2:STE 5
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4727
Mailing Address - Country:US
Mailing Address - Phone:812-618-9284
Mailing Address - Fax:
Practice Address - Street 1:1222 STATE ST
Practice Address - Street 2:STE 3
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4879
Practice Address - Country:US
Practice Address - Phone:812-618-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 225800000X
INXC0002322471C1106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C1106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiac-Interventional Technology
No171000000XOther Service ProvidersMilitary Health Care Provider
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist