Provider Demographics
NPI:1659090777
Name:WASHBURN, PAMELA J
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:WASHBURN
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 1:448 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BRACKNEY
Mailing Address - State:PA
Mailing Address - Zip Code:18812-7959
Mailing Address - Country:US
Mailing Address - Phone:607-765-8554
Mailing Address - Fax:
Practice Address - Street 1:448 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:BRACKNEY
Practice Address - State:PA
Practice Address - Zip Code:18812-7959
Practice Address - Country:US
Practice Address - Phone:607-765-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist