Provider Demographics
NPI:1013284249
Name:KAISER, PAMELA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:KAISER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-0194
Mailing Address - Country:US
Mailing Address - Phone:330-241-7255
Mailing Address - Fax:
Practice Address - Street 1:59 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-0194
Practice Address - Country:US
Practice Address - Phone:330-241-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 142167M IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse