Provider Demographics
NPI:1891024899
Name:VICENTE, PAMELA L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:VICENTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W UNION BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3708
Mailing Address - Country:US
Mailing Address - Phone:610-868-0104
Mailing Address - Fax:610-868-0204
Practice Address - Street 1:623 W UNION BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3708
Practice Address - Country:US
Practice Address - Phone:610-868-0104
Practice Address - Fax:610-868-0204
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001741G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health