Provider Demographics
NPI:1114321148
Name:VALENTINE, PAMELA (RN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:TOLSIDAI
Other - Last Name:BRIPERNAUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7 FRASIER RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12833-1708
Mailing Address - Country:US
Mailing Address - Phone:518-879-8466
Mailing Address - Fax:
Practice Address - Street 1:7 FRASIER RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD CENTER
Practice Address - State:NY
Practice Address - Zip Code:12833-1708
Practice Address - Country:US
Practice Address - Phone:518-879-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328042-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse