Provider Demographics
NPI:1598012718
Name:DENSON, PAMELA LUTREA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LUTREA
Last Name:DENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LUTREA
Other - Last Name:WILLIAMS DENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:956 NW 206TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2387
Mailing Address - Country:US
Mailing Address - Phone:786-306-6514
Mailing Address - Fax:305-749-6623
Practice Address - Street 1:956 NW 206TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2387
Practice Address - Country:US
Practice Address - Phone:786-306-6514
Practice Address - Fax:305-749-6623
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232790376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL232790OtherAHCA REGISTRATION