Provider Demographics
NPI:1730425356
Name:PARDON, PAMELA DENISE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DENISE
Last Name:PARDON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:DENISE
Other - Last Name:PARDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE MSN
Mailing Address - Street 1:1412 W 24TH ST
Mailing Address - Street 2:SAME AS ABOVE
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4438
Mailing Address - Country:US
Mailing Address - Phone:440-245-3344
Mailing Address - Fax:
Practice Address - Street 1:5295 OBERLIN AVE STE A
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3454
Practice Address - Country:US
Practice Address - Phone:440-444-1395
Practice Address - Fax:440-444-1127
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN232663363LP0808X, 163WP0808X
OHAPRNCNP17264363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133139Medicaid