Provider Demographics
NPI:1790500015
Name:REXROAD, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:REXROAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 TATMAN COE RD
Mailing Address - Street 2:
Mailing Address - City:MC DERMOTT
Mailing Address - State:OH
Mailing Address - Zip Code:45652-9004
Mailing Address - Country:US
Mailing Address - Phone:740-935-0750
Mailing Address - Fax:
Practice Address - Street 1:3315 TATMAN COE RD
Practice Address - Street 2:
Practice Address - City:MC DERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652-9004
Practice Address - Country:US
Practice Address - Phone:740-935-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker