Provider Demographics
NPI:1770183642
Name:VARNER, PAM KAY
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:KAY
Last Name:VARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 HIGH GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2666
Mailing Address - Country:US
Mailing Address - Phone:330-256-2400
Mailing Address - Fax:
Practice Address - Street 1:453 HIGH GROVE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2666
Practice Address - Country:US
Practice Address - Phone:330-256-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7718823Medicaid