Provider Demographics
NPI:1306028212
Name:GARNER, PAMELA J (MS FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:GARNER
Suffix:
Gender:F
Credentials:MS FNP
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:120 W MAIN STREET
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529
Mailing Address - Country:US
Mailing Address - Phone:309-742-2921
Mailing Address - Fax:309-742-8411
Practice Address - Street 1:120 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529
Practice Address - Country:US
Practice Address - Phone:309-742-2921
Practice Address - Fax:309-742-8411
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7200613OtherBLUE CROSS BLUE SHIELD
IN7200613OtherBLUE CROSS BLUE SHIELD