Provider Demographics
NPI:1700185055
Name:SARGENT, PAMELA SUE (LVN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10360 MELODY RD
Mailing Address - Street 2:
Mailing Address - City:BIG OAK VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95977-9536
Mailing Address - Country:US
Mailing Address - Phone:530-432-6902
Mailing Address - Fax:
Practice Address - Street 1:10360 MELODY RD
Practice Address - Street 2:
Practice Address - City:BIG OAK VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95977-9536
Practice Address - Country:US
Practice Address - Phone:530-432-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN85472164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse