Healthcare Provider Details

I. General information

NPI: 1730286311
Provider Name (Legal Business Name): PAMELA ANN OLMSTEAD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA ANN OLMSTEAD

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S STATE ST
ANN ARBOR MI
48104-2005
US

IV. Provider business mailing address

1258 NORTH ST
MILAN MI
48160-1195
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-1804
  • Fax:
Mailing address:
  • Phone: 313-969-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704225767
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704225767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: