Provider Demographics
NPI:1831147537
Name:GAMPETRO, PAMELA J (APN CFNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:GAMPETRO
Suffix:
Gender:F
Credentials:APN CFNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:CUBRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 CHILDRENS PLAZA
Mailing Address - Street 2:BOX 30
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-880-4317
Mailing Address - Fax:773-880-6989
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:BOX 37
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-327-5093
Practice Address - Fax:773-327-3937
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q58107Medicare UPIN
ILK23156Medicare ID - Type Unspecified