Provider Demographics
NPI:1003906272
Name:ROUSE, PAMELA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANE
Last Name:ROUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3024
Mailing Address - Country:US
Mailing Address - Phone:916-442-0327
Mailing Address - Fax:916-874-1926
Practice Address - Street 1:12500 BRUCEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757
Practice Address - Country:US
Practice Address - Phone:916-874-1866
Practice Address - Fax:916-874-1926
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN281575163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult