Provider Demographics
NPI:1619620101
Name:DELGADILLO, PAMELA STEPHANIE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:STEPHANIE
Last Name:DELGADILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CENTER RIDGE DR APT 1027
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1281
Mailing Address - Country:US
Mailing Address - Phone:570-926-1492
Mailing Address - Fax:
Practice Address - Street 1:305 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3006
Practice Address - Country:US
Practice Address - Phone:512-339-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064763163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse