Healthcare Provider Details

I. General information

NPI: 1407975725
Provider Name (Legal Business Name): PAM ABERNATHY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR SUITE 110
OXNARD CA
93036-2612
US

IV. Provider business mailing address

6757 WHITEWOOD ST
SIMI VALLEY CA
93063-3950
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4200
  • Fax: 805-981-3341
Mailing address:
  • Phone: 805-981-4200
  • Fax: 805-981-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number369351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: