Provider Demographics
NPI:1821452376
Name:CHUBB, PAMELA SUE (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:CHUBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2483
Mailing Address - Country:US
Mailing Address - Phone:574-523-3432
Mailing Address - Fax:574-296-6590
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-3432
Practice Address - Fax:574-296-6590
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28133607A163W00000X
IN71006287A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse