Provider Demographics
NPI:1336121144
Name:BARDWELL, PAMELA SUSAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUSAN
Last Name:BARDWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BUENA VISTA CIRCLE
Mailing Address - Street 2:CMH-VCU HEALTH
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23919
Mailing Address - Country:US
Mailing Address - Phone:434-447-3751
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:125 BUENA VISTA CIRCLE
Practice Address - Street 2:CMH-VCU HEALTH
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23919
Practice Address - Country:US
Practice Address - Phone:434-447-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024122829367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8945705Medicaid
VA460484OtherBLUE CROSS OF VA
VA460484OtherBLUE CROSS OF VA
VA430001997Medicare ID - Type Unspecified