Provider Demographics
NPI:1457699506
Name:HARRIS, PAMELA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:DEWAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:AZ
Mailing Address - Zip Code:85928-0547
Mailing Address - Country:US
Mailing Address - Phone:928-535-4622
Mailing Address - Fax:928-535-5146
Practice Address - Street 1:3375 BUCKSKIN CANYON RD
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:AZ
Practice Address - Zip Code:85928
Practice Address - Country:US
Practice Address - Phone:928-535-4622
Practice Address - Fax:928-535-5146
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN054891163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse