Provider Demographics
NPI:1902076219
Name:ARCENEAUX, PAMELA JEANNE (IDC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEANNE
Last Name:ARCENEAUX
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEANNE
Other - Last Name:GRZESIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDC
Mailing Address - Street 1:1035 NIDER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 NIDER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2701
Practice Address - Country:US
Practice Address - Phone:757-953-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman