Provider Demographics
NPI:1538614490
Name:ROBERTS, PAMELA M (LPN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 E LEASURE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2423
Mailing Address - Country:US
Mailing Address - Phone:724-971-5478
Mailing Address - Fax:
Practice Address - Street 1:831 HARRISON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4870
Practice Address - Country:US
Practice Address - Phone:724-652-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN261339L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse