Provider Demographics
NPI:1801558960
Name:SMITH, PAMELA J
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:SMITH
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 1:4007 GLENELLEN CT APT 1C
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8234
Mailing Address - Country:US
Mailing Address - Phone:561-714-7634
Mailing Address - Fax:
Practice Address - Street 1:1124 AUSTIN
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-8310
Practice Address - Country:US
Practice Address - Phone:269-445-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator