Provider Demographics
NPI:1912564253
Name:CHURCHILL, PAMELA SUE (CLD,CBC,CD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:CLD,CBC,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PROCTOR HTS DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04088-3160
Mailing Address - Country:US
Mailing Address - Phone:207-615-4966
Mailing Address - Fax:
Practice Address - Street 1:81 PROCTOR HTS DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:ME
Practice Address - Zip Code:04088-3160
Practice Address - Country:US
Practice Address - Phone:207-615-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3069374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula