Provider Demographics
NPI:1326523705
Name:HYDE, PAMELA S
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3122
Mailing Address - Country:US
Mailing Address - Phone:712-310-8335
Mailing Address - Fax:
Practice Address - Street 1:5105 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3546
Practice Address - Country:US
Practice Address - Phone:531-299-7060
Practice Address - Fax:531-299-2479
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098956163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool