Provider Demographics
NPI:1538949052
Name:PATTON, VICTORIA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:PATTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:JUPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1173 RUSSELL LEA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8785
Mailing Address - Country:US
Mailing Address - Phone:517-291-3685
Mailing Address - Fax:
Practice Address - Street 1:3404 PATIENT CARE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4217
Practice Address - Country:US
Practice Address - Phone:517-267-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily