Provider Demographics
NPI:1669752598
Name:ANDERSON, PAMELA M (LME)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 BERWICK CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8560
Mailing Address - Country:US
Mailing Address - Phone:216-440-8905
Mailing Address - Fax:
Practice Address - Street 1:458 BERWICK CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8560
Practice Address - Country:US
Practice Address - Phone:216-440-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHESTM.071064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist