Provider Demographics
NPI:1073704029
Name:FOX, PAMELA RYDER (APRNFNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:RYDER
Last Name:FOX
Suffix:
Gender:F
Credentials:APRNFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LONG CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2440
Mailing Address - Country:US
Mailing Address - Phone:207-879-0094
Mailing Address - Fax:207-879-0095
Practice Address - Street 1:25 LONG CREEK DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2440
Practice Address - Country:US
Practice Address - Phone:207-879-0094
Practice Address - Fax:207-879-0095
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDC0798OtherRAILROAD MEDICARE
MEDC0798OtherRAILROAD MEDICARE
MAS52948Medicare UPIN