Provider Demographics
NPI:1528211760
Name:ISLEY, PAMELA (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ISLEY
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 1:3426 LAKE AVE
Mailing Address - Street 2:#120
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3877
Mailing Address - Country:US
Mailing Address - Phone:719-561-5264
Mailing Address - Fax:
Practice Address - Street 1:3426 LAKE AVE
Practice Address - Street 2:#120
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3877
Practice Address - Country:US
Practice Address - Phone:719-561-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99806363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health