Provider Demographics
NPI:1033785548
Name:WYMAN, PAMELA SUE (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:WYMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4548
Mailing Address - Country:US
Mailing Address - Phone:916-666-7215
Mailing Address - Fax:916-746-0070
Practice Address - Street 1:729 SUNRISE AVE STE 610
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4548
Practice Address - Country:US
Practice Address - Phone:916-666-7215
Practice Address - Fax:916-746-0070
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016786363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care