Provider Demographics
NPI:1457474348
Name:SEGEL, PAMELA MICHELE (DS III, EDS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELE
Last Name:SEGEL
Suffix:
Gender:F
Credentials:DS III, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 RANCHO PARAISO NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5822
Mailing Address - Country:US
Mailing Address - Phone:505-898-3029
Mailing Address - Fax:
Practice Address - Street 1:8215 RANCHO PARAISO NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5822
Practice Address - Country:US
Practice Address - Phone:505-898-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist