Provider Demographics
NPI:1841436243
Name:SABELLA, PAMELA SUE (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:SABELLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12917 OAK LAWN PL
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2260
Mailing Address - Country:US
Mailing Address - Phone:631-921-4214
Mailing Address - Fax:
Practice Address - Street 1:LOUDOUN FREE CLINIC
Practice Address - Street 2:224A CORNWALL STREET, NW
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-779-5416
Practice Address - Fax:703-779-5407
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9275045363LA2200X
NYF302615363LA2200X
VA0024176746363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF302615OtherSTATE LICENSE NUMBER
FL9275045OtherADULT NURSE PRACTITIONER LICENSE
FL001366000Medicaid
FL9275045OtherSTATE LICENSE NUMBER
VA0017145343OtherLICENSE TO PRESCRIBE
VA0024176746OtherLICENSED NURSE PRACTITIONER