Provider Demographics
NPI:1740438472
Name:HENEL, PAMELA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:HENEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 YVETTE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3418
Mailing Address - Country:US
Mailing Address - Phone:716-675-4641
Mailing Address - Fax:716-675-4641
Practice Address - Street 1:58 YVETTE DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3418
Practice Address - Country:US
Practice Address - Phone:716-675-4641
Practice Address - Fax:716-675-4641
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167495-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02902532Medicaid