Provider Demographics
NPI:1174867220
Name:WHITE, PAMELA J (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BROOKLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4300
Mailing Address - Country:US
Mailing Address - Phone:315-525-0081
Mailing Address - Fax:315-533-1173
Practice Address - Street 1:115 SENECA AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2561
Practice Address - Country:US
Practice Address - Phone:315-525-0081
Practice Address - Fax:315-533-1173
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse