Provider Demographics
NPI:1861510976
Name:HAVERLY, PAMELA S (RN,BSN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:HAVERLY
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8127 TANAGER COURT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1775
Mailing Address - Country:US
Mailing Address - Phone:317-594-8614
Mailing Address - Fax:
Practice Address - Street 1:8127 TANAGER CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1775
Practice Address - Country:US
Practice Address - Phone:317-594-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28094896A163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine