Provider Demographics
NPI:1174853345
Name:MCBRIDE, PAMELA CHRISTINE (ANP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5321
Mailing Address - Country:US
Mailing Address - Phone:719-440-6567
Mailing Address - Fax:
Practice Address - Street 1:3100 NORTH ACADEMY BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5321
Practice Address - Country:US
Practice Address - Phone:719-440-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92753363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10051OtherANP
CO92753OtherRN