Provider Demographics
NPI:1255014189
Name:ROPER, PAMELA S (LM)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:ROPER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6477 WALKER LN
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8541
Mailing Address - Country:US
Mailing Address - Phone:208-946-0156
Mailing Address - Fax:855-731-1395
Practice Address - Street 1:6477 WALKER LN
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8541
Practice Address - Country:US
Practice Address - Phone:208-946-0156
Practice Address - Fax:855-731-1395
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-145176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife