Healthcare Provider Details

I. General information

NPI: 1811313968
Provider Name (Legal Business Name): PAMELA VALDA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 42ND PL N
BIRMINGHAM AL
35222-1137
US

IV. Provider business mailing address

608 42ND PL N
BIRMINGHAM AL
35222-1137
US

V. Phone/Fax

Practice location:
  • Phone: 205-410-3224
  • Fax:
Mailing address:
  • Phone: 205-410-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1048813
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: