Healthcare Provider Details

I. General information

NPI: 1144358532
Provider Name (Legal Business Name): MRS. PAM ELIZABETH CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAM ELIZABETH LEARY NP

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HEALTH SERVCICES 2222 BANCROFT WAY
BERKELEY CA
94720-4300
US

IV. Provider business mailing address

116 PARKSIDE DR
BERKELEY CA
94705-2412
US

V. Phone/Fax

Practice location:
  • Phone: 510-643-9169
  • Fax: 510-643-5079
Mailing address:
  • Phone: 510-653-4592
  • Fax: 510-653-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number409372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: