Provider Demographics
NPI:1730286311
Name:OLMSTEAD, PAMELA ANN (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:OLMSTEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1258 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1195
Mailing Address - Country:US
Mailing Address - Phone:313-969-3685
Mailing Address - Fax:
Practice Address - Street 1:209 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2005
Practice Address - Country:US
Practice Address - Phone:734-769-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704225767363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
2006004546-22OtherAMERICAN NURS CRED CTR
MI4704225767OtherLICENSE
MIP35120012Medicare PIN