Provider Demographics
NPI:1417380346
Name:KIELBOWICZ, PAMELA LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYNN
Last Name:KIELBOWICZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 E PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-1703
Mailing Address - Country:US
Mailing Address - Phone:702-378-2275
Mailing Address - Fax:480-889-0088
Practice Address - Street 1:1345 E MAIN ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8947
Practice Address - Country:US
Practice Address - Phone:480-223-0090
Practice Address - Fax:480-889-0088
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily