Provider Demographics
NPI:1508755505
Name:PATTERSON, MARTY DEWAYNE
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:DEWAYNE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4515
Mailing Address - Country:US
Mailing Address - Phone:402-904-0488
Mailing Address - Fax:
Practice Address - Street 1:3107 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4515
Practice Address - Country:US
Practice Address - Phone:901-631-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health