Basic Information
| Provider Information | |||||||||
| NPI: | 1063843340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | ELZONA | ||||||||
| MiddleName: | MAE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2481 LLEWELLYN AVENUE | ||||||||
| Address2: | |||||||||
| City: | FORT MEADE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016778749 | ||||||||
| FaxNumber: | 3016778957 | ||||||||
| Practice Location | |||||||||
| Address1: | 2481 LLEWELLYN AVENUE | ||||||||
| Address2: | |||||||||
| City: | FORT MEADE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016778749 | ||||||||
| FaxNumber: | 3016778957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 26NR12203000 | NJ | N | Hospitals | Military Hospital | 363LP0808X | 26NJ00452300 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.