Provider Demographics
NPI:1740615368
Name:HAIRSTON, PAMELA C (LVN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:C
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14515 HAMLIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1608
Mailing Address - Country:US
Mailing Address - Phone:818-989-7475
Mailing Address - Fax:818-908-3424
Practice Address - Street 1:14515 HAMLIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1608
Practice Address - Country:US
Practice Address - Phone:818-989-7475
Practice Address - Fax:818-908-2434
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN271569164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse