Provider Demographics
NPI:1639534522
Name:BUREAU, PAMELA MARIE (RN, CDE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:BUREAU
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:MCINNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3555 EWING AVENUE
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163
Mailing Address - Country:US
Mailing Address - Phone:813-334-7162
Mailing Address - Fax:
Practice Address - Street 1:1020 LAKE SUMTER LANDING
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-753-6214
Practice Address - Fax:352-674-8919
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3002462163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator