Provider Demographics
NPI:1972134112
Name:ADAM, PAMELA J (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:ADAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:421 ILIWAHI LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1837
Mailing Address - Country:US
Mailing Address - Phone:808-349-3265
Mailing Address - Fax:
Practice Address - Street 1:45-691 KEAAHALA RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3569
Practice Address - Country:US
Practice Address - Phone:808-233-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN36419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse