Provider Demographics
NPI:1558823724
Name:STEARNS, PAMELA JO (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:STEARNS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 COUNTY ROAD 36
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9404
Mailing Address - Country:US
Mailing Address - Phone:260-704-7166
Mailing Address - Fax:
Practice Address - Street 1:10066 CRABAPPLE LN
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9641
Practice Address - Country:US
Practice Address - Phone:574-612-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4704160313163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1780932053OtherSELF PAY