Provider Demographics
NPI:1841655669
Name:NULL, PAMELA ANN (CRNP, NP-C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:NULL
Suffix:
Gender:F
Credentials:CRNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1413
Mailing Address - Country:US
Mailing Address - Phone:814-299-7520
Mailing Address - Fax:814-375-7798
Practice Address - Street 1:635 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2376
Practice Address - Country:US
Practice Address - Phone:814-375-6379
Practice Address - Fax:814-375-9320
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015397363LF0000X
PASP029112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP029112OtherPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER