Provider Demographics
NPI:1437805439
Name:TURNER, PAMELA MANDESA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MANDESA
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 S 25TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4739
Mailing Address - Country:US
Mailing Address - Phone:772-626-5574
Mailing Address - Fax:772-742-8503
Practice Address - Street 1:1905 S 25TH ST STE 105
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4739
Practice Address - Country:US
Practice Address - Phone:772-626-5574
Practice Address - Fax:772-742-8503
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker