Provider Demographics
NPI:1184808206
Name:MCGILL, PAMELA JEAN (PMHNP, MSN)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PMHNP, MSN
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:JOHNSON/MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:4856 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5540
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:
Practice Address - Street 1:1250 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4461
Practice Address - Country:US
Practice Address - Phone:970-494-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990105-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health