Provider Demographics
NPI:1619252947
Name:GRABER, PAMALA LEANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:LEANNE
Last Name:GRABER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-1308
Mailing Address - Country:US
Mailing Address - Phone:716-926-2370
Mailing Address - Fax:716-549-2380
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-1308
Practice Address - Country:US
Practice Address - Phone:716-926-2370
Practice Address - Fax:716-549-2380
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454766163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool