Provider Demographics
NPI:1881683928
Name:RICO, PAMELA BRANDY (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:BRANDY
Last Name:RICO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49063 ROAD 426
Mailing Address - Street 2:SUITE C
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9487
Mailing Address - Country:US
Mailing Address - Phone:559-642-1500
Mailing Address - Fax:559-642-1506
Practice Address - Street 1:49063 ROAD 426
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9487
Practice Address - Country:US
Practice Address - Phone:559-642-1500
Practice Address - Fax:559-642-1506
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q62933Medicare UPIN