Provider Demographics
NPI:1376037994
Name:DUFREN, PAMELA DOMINIQUE (CSFA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DOMINIQUE
Last Name:DUFREN
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21365 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-4793
Mailing Address - Country:US
Mailing Address - Phone:985-237-4551
Mailing Address - Fax:
Practice Address - Street 1:21365 E BELL RD
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-4793
Practice Address - Country:US
Practice Address - Phone:985-237-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
180803246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist