Individual
TAREE PATILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
410 BERMUDA LN, LOUISVILLE, KY 40213-3318
(502) 203-5130
Mailing address
410 BERMUDA LN, LOUISVILLE, KY 40213-3318
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2053107
KY
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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