Provider Demographics
NPI:1003907866
Name:SMITH, PAMELA ANN (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 PHEASANT WAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-3221
Mailing Address - Country:US
Mailing Address - Phone:508-790-7557
Mailing Address - Fax:
Practice Address - Street 1:59 PHEASANT WAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-3221
Practice Address - Country:US
Practice Address - Phone:508-790-7557
Practice Address - Fax:508-790-2331
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166670164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse