Provider Demographics
NPI:1033987755
Name:PAMER, VANESSA LYNN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:PAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23921 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2814
Mailing Address - Country:US
Mailing Address - Phone:440-360-0067
Mailing Address - Fax:
Practice Address - Street 1:23921 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2814
Practice Address - Country:US
Practice Address - Phone:440-360-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide