Provider Demographics
NPI:1700609138
Name:ISREAL, PAMELA DENISE
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DENISE
Last Name:ISREAL
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 1:5935 LYNNAWAY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2533
Mailing Address - Country:US
Mailing Address - Phone:937-825-3563
Mailing Address - Fax:
Practice Address - Street 1:5935 LYNNAWAY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2533
Practice Address - Country:US
Practice Address - Phone:937-825-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide