Provider Demographics
NPI:1073734034
Name:ALISSANDRATOS, PAM SUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:SUE
Last Name:ALISSANDRATOS
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:RR 2 BOX 153
Mailing Address - Street 2:
Mailing Address - City:VALLEY GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26060-8929
Mailing Address - Country:US
Mailing Address - Phone:304-547-1053
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 256A
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-9725
Practice Address - Country:US
Practice Address - Phone:304-547-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21366164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse