Provider Demographics
NPI:1548998826
Name:GAENG, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GAENG
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 1:262 WELL RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:PA
Mailing Address - Zip Code:18425-9752
Mailing Address - Country:US
Mailing Address - Phone:570-470-2608
Mailing Address - Fax:
Practice Address - Street 1:750 ROUTE 739
Practice Address - Street 2:
Practice Address - City:LORDS VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-6058
Practice Address - Country:US
Practice Address - Phone:570-775-7100
Practice Address - Fax:570-775-0950
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty