Individual
LACEY STORM PATTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
401 BROAD ST, JOHNSTOWN, PA 15906-2716
(814) 535-6000
Mailing address
401 BROAD ST, JOHNSTOWN, PA 15906-2716
(814) 535-6000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
665503
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163W00000X
—
PA
05
—
9123
—
PA
Enumeration date
05/29/2019
Last updated
05/29/2019
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