Individual
PATRICE STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6810 STATE ROUTE 162 SUITE 105, MARYVILLE, IL 62062-8501
(618) 288-9320
(618) 288-9258
Mailing address
6810 STATE ROUTE 162 BOX 215, MARYVILLE, IL 62062-8501
(618) 391-6405
(618) 288-4088
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036106866
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106866001
—
IL
Enumeration date
12/11/2006
Last updated
03/27/2020
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