Healthcare Provider Details

I. General information

NPI: 1366698375
Provider Name (Legal Business Name): PAMELA MAE WRIGHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 08/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

327 COLEMAN DR
SAN RAFAEL CA
94901-1210
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1978
  • Fax:
Mailing address:
  • Phone: 415-453-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: