Provider Demographics
NPI:1679276760
Name:NICHOLS, PAMELA DIMITRIUS
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIMITRIUS
Last Name:NICHOLS
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 1:518 E REVERE CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3235
Mailing Address - Country:US
Mailing Address - Phone:609-816-4860
Mailing Address - Fax:
Practice Address - Street 1:518 E REVERE CT
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-3235
Practice Address - Country:US
Practice Address - Phone:609-816-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula