Provider Demographics
NPI:1609161033
Name:MARTIN, PAMELA M (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:BRUSHTON
Mailing Address - State:NY
Mailing Address - Zip Code:12916-0543
Mailing Address - Country:US
Mailing Address - Phone:518-521-4561
Mailing Address - Fax:
Practice Address - Street 1:1280 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:BRUSHTON
Practice Address - State:NY
Practice Address - Zip Code:12916
Practice Address - Country:US
Practice Address - Phone:518-353-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579937-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse