Provider Demographics
NPI:1376633719
Name:DICKERHOOF, PAMELA A (RN03/22/1955)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:DICKERHOOF
Suffix:
Gender:F
Credentials:RN03/22/1955
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 BERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8501
Mailing Address - Country:US
Mailing Address - Phone:330-533-8912
Mailing Address - Fax:
Practice Address - Street 1:7070 BERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8501
Practice Address - Country:US
Practice Address - Phone:330-533-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 151361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586901OtherTAX ID NUMBER