Provider Demographics
NPI:1295019552
Name:REYNOLDS, PAMELA ANN (APN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:JURASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:1810 HADDONFIELD BERLIN RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3736
Practice Address - Country:US
Practice Address - Phone:856-795-3313
Practice Address - Fax:856-354-8780
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09518500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner