Provider Demographics
NPI:1225339252
Name:MARCISZEWSKI, PAMELA SUE (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:MARCISZEWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5421 JONATHAN ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32145-6606
Mailing Address - Country:US
Mailing Address - Phone:386-325-6152
Mailing Address - Fax:
Practice Address - Street 1:5421 JONATHAN ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:FL
Practice Address - Zip Code:32145-6606
Practice Address - Country:US
Practice Address - Phone:386-325-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263877164W00000X
FLPN5195624164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse