Provider Demographics
NPI:1013202977
Name:MARSH, PAMELA REBECCA (PNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:REBECCA
Last Name:MARSH
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:REBECCA
Other - Last Name:FREITAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP-BC
Mailing Address - Street 1:360 W BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0207
Mailing Address - Country:US
Mailing Address - Phone:559-801-1997
Mailing Address - Fax:
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-801-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20021363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics