Provider Demographics
NPI:1174960850
Name:ECCLESTON-BARRETT, PATRICIA (LPN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ECCLESTON-BARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:E
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 SAINT JOHN AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4411
Mailing Address - Country:US
Mailing Address - Phone:347-385-0090
Mailing Address - Fax:
Practice Address - Street 1:12 SAINT JOHN AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4411
Practice Address - Country:US
Practice Address - Phone:347-385-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180430164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse