MEDICARE: MRS. PAMELA MELISSA WAINER APRN, CPNP-AC

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	363LP0200X	Pediatric Nurse Practitioner	AP117864	TX

General Provider Information

NPI Number	:	1518101971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA MELISSA WAINER APRN, CPNP-AC

Provider Business Mailing Address
First Line	:	5750 PINELAND DR STE 260
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5300
Country	:	US
Telephone Number	:	469-637-4204
Fax Number	:	469-637-4586

Provider Business Practice Location Address
First Line	:	5750 PINELAND DR STE 260
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5300
Country	:	US
Telephone Number	:	469-637-4204
Fax Number	:	469-637-4586

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

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	05/24/2022

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