MEDICARE: PAMELA KAY MARIE KLASSEN RN, FNP-BC, ARNP,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	664234	TX
2	364SM0705X	Medical-Surgical Clinical Nurse Specialist	664234	TX
3	363LF0000X	Family Nurse Practitioner	AP60288007	WA

General Provider Information

NPI Number	:	1356653919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA KAY MARIE KLASSEN RN, FNP-BC, ARNP,

Provider Business Mailing Address
First Line	:	P. O. BOX 465
Second Line	:
City	:	KALEDEN
State	:	B.C.
Zip	:	V0H 1K0
Country	:	CA
Telephone Number	:	250-497-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 W OCEAN BLVD
Second Line	:	SUITE 104
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-3667
Country	:	US
Telephone Number	:	956-233-2163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2010
Last Update Date	:	05/28/2012

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