Provider Demographics
NPI:1790391977
Name:CLARIDA, PAMELA J (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:CLARIDA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-3711
Mailing Address - Country:US
Mailing Address - Phone:618-972-9326
Mailing Address - Fax:
Practice Address - Street 1:2808 E OUTER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5207
Practice Address - Country:US
Practice Address - Phone:618-993-3817
Practice Address - Fax:618-993-3908
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020024176363LF0000X
IL209021732363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily