Provider Demographics
NPI:1336203728
Name:SPAIN, PAMELA JOAN (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOAN
Last Name:SPAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3560
Mailing Address - Country:US
Mailing Address - Phone:925-944-0916
Mailing Address - Fax:
Practice Address - Street 1:1500 D ST RM 601
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2346
Practice Address - Country:US
Practice Address - Phone:925-777-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164935163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163WS0200XOtherR.N. SCHOOL