Provider Demographics
NPI:1972818367
Name:BARRETT, PAMELA SUE (DOM)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:SUE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 GENERAL STILWELL ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1028
Mailing Address - Country:US
Mailing Address - Phone:505-850-8576
Mailing Address - Fax:
Practice Address - Street 1:7510 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 206
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1500
Practice Address - Country:US
Practice Address - Phone:505-884-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist