Provider Demographics
NPI:1225054638
Name:LAYTON, PAMELA E (OB/GYN NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
Last Name:LAYTON
Suffix:
Gender:F
Credentials:OB/GYN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PORTLAND AVE. SO.
Mailing Address - Street 2:HSB 4TH FLOOR, MC 952
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-348-9840
Mailing Address - Fax:612-596-7900
Practice Address - Street 1:525 PORTLAND AVE. SO.
Practice Address - Street 2:HSB 4TH FLOOR, MC 952
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-348-9840
Practice Address - Fax:612-596-7900
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-135990-9363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111697500Medicaid
MN40D78LAOtherBLUE CROSS BLUE SHIELD
MN07-01403OtherMEDICA
MN40D78LAOtherBLUE CROSS BLUE SHIELD
MN500001479Medicare ID - Type Unspecified