Provider Demographics
NPI:1184993271
Name:BARNES, PAMELA IRENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:IRENE
Last Name:BARNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 AVALON CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473
Mailing Address - Country:US
Mailing Address - Phone:330-609-5113
Mailing Address - Fax:330-609-5113
Practice Address - Street 1:705 AVALON CREEK BLVD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:OH
Practice Address - Zip Code:44473
Practice Address - Country:US
Practice Address - Phone:330-609-5113
Practice Address - Fax:330-609-5113
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN071761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse