Provider Demographics
NPI:1760614838
Name:HANDLEY, PAMELA J (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:HANDLEY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12265 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8805
Mailing Address - Country:US
Mailing Address - Phone:810-750-0489
Mailing Address - Fax:
Practice Address - Street 1:2222 S LINDEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5475
Practice Address - Country:US
Practice Address - Phone:810-733-0790
Practice Address - Fax:810-733-0235
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117621363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP33590020Medicare PIN