Provider Demographics
NPI:1083797518
Name:NETHERY, PAMELA SUE (APRN, BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:NETHERY
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:LAURSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:15312 BROOKLODGE RD.
Mailing Address - Street 2:
Mailing Address - City:HICKORY CORNERS
Mailing Address - State:MI
Mailing Address - Zip Code:49060-9740
Mailing Address - Country:US
Mailing Address - Phone:269-671-4850
Mailing Address - Fax:269-671-4850
Practice Address - Street 1:327 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3924
Practice Address - Country:US
Practice Address - Phone:269-969-6040
Practice Address - Fax:269-969-6041
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily