Provider Demographics
NPI:1689754228
Name:PASSAFIUME, PAMELA (CRNA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PASSAFIUME
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 822337
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2337
Mailing Address - Country:US
Mailing Address - Phone:866-226-9156
Mailing Address - Fax:
Practice Address - Street 1:4005 DUPONT CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4801
Practice Address - Country:US
Practice Address - Phone:502-897-7401
Practice Address - Fax:502-897-5652
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1071808367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74207903Medicaid
KY0782329Medicare ID - Type Unspecified