Provider Demographics
NPI:1619183746
Name:GOODRICH, PAMELA JANE (LPN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WENTWORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-878-3178
Mailing Address - Fax:
Practice Address - Street 1:90 LOMBARD LN
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4302
Practice Address - Country:US
Practice Address - Phone:802-372-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0250008725164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse