Provider Demographics
NPI:1417133513
Name:DIMITRIE, PAMELA P (RN,BSN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:P
Last Name:DIMITRIE
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 TOWNER ST
Mailing Address - Street 2:PO BOX 915
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5752
Mailing Address - Country:US
Mailing Address - Phone:734-544-3015
Mailing Address - Fax:734-544-6732
Practice Address - Street 1:2940 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7406
Practice Address - Country:US
Practice Address - Phone:734-434-2559
Practice Address - Fax:734-434-1511
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704112145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse