Provider Demographics
NPI:1710297411
Name:RUANE, PAMELA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEE
Last Name:RUANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-1517
Mailing Address - Country:US
Mailing Address - Phone:272-228-9418
Mailing Address - Fax:
Practice Address - Street 1:615 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3703
Practice Address - Country:US
Practice Address - Phone:570-288-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054627363AM0700X
NJ25MP00289000363AM0700X
VA0110003437363AM0700X
PAOA002547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical