Provider Demographics
NPI:1275625865
Name:NORRIS, PAMELA J (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:NORRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2101
Mailing Address - Country:US
Mailing Address - Phone:309-664-3120
Mailing Address - Fax:309-664-5742
Practice Address - Street 1:1701 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2101
Practice Address - Country:US
Practice Address - Phone:309-664-3120
Practice Address - Fax:309-664-5742
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041207086/209000471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S82680Medicare UPIN
IL546380Medicare ID - Type UnspecifiedINDIVIDUAL #
ILK36966Medicare ID - Type UnspecifiedINDIVIDUAL # EFF 5-22-07
ILCA2264Medicare ID - Type UnspecifiedRR GROUP #
IL833120Medicare ID - Type UnspecifiedGROUP # EFF 5-22-07
IL500008617Medicare ID - Type UnspecifiedRR INDIVIDUAL #