Provider Demographics
NPI:1629169206
Name:NETUSCHIL, PAMELA E (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
Last Name:NETUSCHIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6160
Mailing Address - Country:US
Mailing Address - Phone:775-432-1343
Mailing Address - Fax:775-324-0858
Practice Address - Street 1:6580 S MCCARRAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6160
Practice Address - Country:US
Practice Address - Phone:775-432-1343
Practice Address - Fax:775-324-0858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016898Medicaid
NV002016898Medicaid
NVG61446Medicare UPIN