Provider Demographics
NPI:1821367590
Name:ABBOTT, PAMELA JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 FARMERS INN RD
Mailing Address - Street 2:P.O. BOX 508
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-4112
Mailing Address - Country:US
Mailing Address - Phone:518-859-7817
Mailing Address - Fax:
Practice Address - Street 1:156 8TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1043
Practice Address - Country:US
Practice Address - Phone:518-506-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243612-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse