Provider Demographics
NPI:1881878528
Name:DE MERS, PAMELA MICHELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MICHELLE
Last Name:DE MERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34730 BOB WILSON DR
Mailing Address - Street 2:BLDG3, FLOOR 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-3400
Mailing Address - Country:US
Mailing Address - Phone:619-532-7177
Mailing Address - Fax:
Practice Address - Street 1:34730 BOB WILSON DR
Practice Address - Street 2:BUILDING 3, FLOOR 4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3400
Practice Address - Country:US
Practice Address - Phone:619-532-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17460363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS399ZMedicaid