Provider Demographics
NPI:1700012937
Name:VERA, PAMELA JOY (LPN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JOY
Last Name:VERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JOY
Other - Last Name:STELZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:2805 COIT AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3383
Mailing Address - Country:US
Mailing Address - Phone:616-365-9290
Mailing Address - Fax:616-365-9254
Practice Address - Street 1:2805 COIT AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3383
Practice Address - Country:US
Practice Address - Phone:616-365-9290
Practice Address - Fax:616-365-9254
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703081803164W00000X
FL4703081803164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse