Provider Demographics
NPI:1710291216
Name:HARRISON, PAMELA D (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:D
Other - Last Name:ELSWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 890
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614
Mailing Address - Country:US
Mailing Address - Phone:276-531-8103
Mailing Address - Fax:276-531-8106
Practice Address - Street 1:28567 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-531-8103
Practice Address - Fax:276-531-8106
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily