Provider Demographics
NPI:1033303789
Name:GIAMBRONE, PAMELA JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JO
Last Name:GIAMBRONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2850
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-2850
Mailing Address - Country:US
Mailing Address - Phone:520-866-3500
Mailing Address - Fax:520-868-0798
Practice Address - Street 1:2700 N. ANTHEM WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-6649
Practice Address - Country:US
Practice Address - Phone:520-723-6400
Practice Address - Fax:520-723-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043178390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLP043178Medicaid