Provider Demographics
NPI:1912237413
Name:MILES, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MILES
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 1:2233 SENECA ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2437
Mailing Address - Country:US
Mailing Address - Phone:716-990-7067
Mailing Address - Fax:
Practice Address - Street 1:2233 SENECA ST
Practice Address - Street 2:APT. 1
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2437
Practice Address - Country:US
Practice Address - Phone:716-990-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298187-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse