Provider Demographics
NPI:1821035981
Name:STARK, PAMELA HARRINGTON (CRNA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:HARRINGTON
Last Name:STARK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 ASTORIA PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7399
Mailing Address - Country:US
Mailing Address - Phone:919-784-9240
Mailing Address - Fax:
Practice Address - Street 1:7617 ASTORIA PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7399
Practice Address - Country:US
Practice Address - Phone:919-784-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRN 150792367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered