Provider Demographics
NPI:1134700404
Name:ELLIS, PAMELA (BS, BSN, CDCES)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:BS, BSN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 GLENN MITCHELL DR
Mailing Address - Street 2:2ND FLOOR EDUCATION DEPARTMENT
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0178
Mailing Address - Country:US
Mailing Address - Phone:757-507-2711
Mailing Address - Fax:
Practice Address - Street 1:2025 GLENN MITCHELL DR
Practice Address - Street 2:2ND FLOOR EDUCATION DEPARTMENT
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0178
Practice Address - Country:US
Practice Address - Phone:757-507-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001228063163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
6875147OtherDPRP ASSIGNED ORGANIZATIONAL CODE